Resources

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.

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.

Frequently asked questions about the Practitioner Review Program.

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 guideline can help you to substantiate Child Dental Benefits Schedule (CDBS) services that you have claimed or that have been claimed through your provider number. You must also show that consent to dental services and costs has been obtained and recorded.

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.