Medicare compliance resources

This is the second of two complementary AskMBS advisories on allied health MBS items.

Information and advice for general practitioners and other medical practitioners about the COVID-19 MBS telehealth ‘existing relationship’ requirement, including a clarification of exemptions.

This pubic register records data matching undertaken for Medicare compliance purposes. <cite>Part VIIIA of the National Health Act 1953</cite> requires the Chief Executive Medicare to maintain this register.

AskMBS answers questions from health professionals about the Medicare Benefits Schedule

This document outlines the terms of use for health providers when using the Department of Health Online Compliance Platform to respond to the Department’s request to conduct compliance activities.

This document provides information on how Department of Health handles health providers’ personal information when provider use the Online Compliance Platform to respond to the Department’s request to conduct compliance activities.

This guideline outlines what you can do to substantiate diagnostic imaging and pathology services rendered to emergency department patients of public hospitals and claimed under Medicare.

This guideline outlines what you can do to substantiate that you as a consultant physician or specialist personally performed a referred consultation service on a private patient in a public hospital claimed under the Medicare Benefits Schedule (MBS).

This guideline outlines how you can substantiate services provided under rights of private practice at public hospital outpatient departments.

This guide is for dentists and explains the arrangements and requirements for the Child Dental Benefits Schedule (CDBS).

A factsheet has been developed to assist practitioners in preparing Type C certification, for submission to private health insurers, where rTMS treatment is provided in hospital. It also provides guidance on what to include when correctly completing Type C certificates.

Medical practitioners can refer eligible patients with chronic diseases to allied health practitioners. Allied health practitioners can claim Medicare benefits for some services as explained in the Allied Health checklist.

This document details how eligible patients should be billed for MBS items 10950 to 10970, including referral requirements, resources and access.

Advice for health providers and other users of the Medicare Benefits Schedule on the interpretation and application of MBS items, explanatory notes and associated legislation, to assist them in billing Medicare correctly.

Social workers can provide focussed psychological strategies (FPS) under the Better Access Initiative (BAI), where their clients can access up to 10 individual sessions per calendar year.

The Health Provider Compliance Strategy aims to help health providers understand their responsibilities in relation to compliance. It outlines the Department's compliance priorities for the 2021-22 financial year and describes the tools and methods used to identify and treat non-compliance.

This fact sheet provides advice on preparing a submission.

This short guide describes how the Practitioner Review Program (PRP) is applied to practitioners whose Medicare servicing data (inclusive of Medicare claims and PBS prescribing data) indicates possible inappropriate practice.

Under the Health Insurance Act 1973 (Health Insurance Act), a person (including a practitioner) engages in inappropriate practice if they knowingly, recklessly or negligently cause or permit a practitioner who they employ or otherwise engage to engage in inappropriate practice.

Advice for health providers and other users of the Medicare Benefits Schedule on the interpretation and application of MBS items, explanatory notes and associated legislation, to assist them in billing Medicare correctly.

The purpose of the Notice is to provide transparency and public awareness in relation to data matching which is undertaken for a permitted purpose under the <cite>National Health Act 1953 (National Health Act)</cite>, as part of Medicare provider compliance.

These FAQs answer commonly asked questions on public hospital funding for public patients, and appropriate Medicare billing for private patients in public hospitals.

What general practitioners and other medical practitioners need to know about how the 80/20 rule and high volumes of rendered services.

Information and advice for providers about Medicare compliance.

The Pharmaceutical Services Federal Committee of Inquiry (the Committee) was established by the Minister to address concerns that some instances of claiming contravened the National Health Act 1953.