Publications

Information about the purpose of the Practitioner Review Program (PRP), how inappropriate practice is identified, how a PRP case is conducted, and participating in the PRP process.

This fact sheet provides advice on preparing a submission.

Information on the new prescribed pattern of service 30/20 telephone rule, including relevant telephone attendance services. From 1 October 2022, GPs, Other Medical Practitioners and consultant physicians that claim relevant Medicare telephone items will be subject to the new rule.

Frequently asked questions about the Practitioner Review Program.

Information about how a breach of the prescribed pattern of services (the 80/20 and 30/20 rules) is detected and the next steps when an 80/20 or 30/20 breach is found.

Information on the definition of inappropriate practice and how it applies to practitioners and corporate entities.

Information on the common compliance issues associated with inappropriate practice based on Professional Services Review outcomes.

Information on how to avoid practicing inappropriately, your responsibilities and sources of information to meet Medicare requirements.

Information about the Practitioner Review Program (PRP) interview

Information about the Practitioner Review Program (PRP) 6-month period of review.

Information about the Practitioner Review Program (PRP) where practitioners are referred to a delegate of the Chief Executive Medicare (delegate) after an interview without a six-month period of review.

Information about the Practitioner Review Program (PRP) and the review by a delegate of the Chief Executive Medicare (delegate).

Information about inappropriate practice and prescribed pattern of services (the 80/20 and 30/20 rules) and which professional attendance services apply.

Information on legislative requirements and considerations when there is a breach of the prescribed pattern of services (the 80/20 and 30/20 rules)

Information on the department’s role in identifying and intervening with practitioners and corporate entities where potential inappropriate is found.

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.

This snapshot shows this Mission at a glance. It includes budgets, early funding priorities and grant timelines, as at November 2019. Researchers and other stakeholders can use it to plan for upcoming opportunities and see how the Mission will be established, expanded and embedded over time.

This guideline outlines what you can do to substantiate a service to be requested by another medical practitioner for Medicare Benefits Schedule (MBS) items 57521 and 65070.

This guideline outlines what you can do to substantiate Medicare Benefits Schedule (MBS) items 104, 105, 110, 116, 122, 132, 133, 135, 141, 143, 145 and 147 that require receipt of a valid referral before the service is provided.

This guideline outlines what you can do to substantiate valid general ears, nose and throat surgical services were provided such as Medicare Benefits Schedule (MBS) items 41846, 41764 and 30473.

This guideline outlines what you can do to substantiate the coordination of the development of Team Care Arrangements rendered by eligible medical practitioners for Medicare Benefits Schedule (MBS) item 723.

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

This guideline is particularly for diabetes educators, exercise physiologists or dietitians. It MBS items 81100 to 81125 and can help you substantiate that the requirements for an assessment service or group allied health service for a patient with type 2 diabetes have been met.

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 what you can do to substantiate the preparation of a valid GP Mental Health Treatment Plan rendered by eligible medical practitioners for Medicare Benefits Schedule (MBS) items 2700, 2701, 2715 and 2717.