Resources

This guideline outlines what you can do to substantiate that a patient attended a service and relates to Medicare Benefits Schedule (MBS) items such as 23, 36, 104, 5020, 10960 and 8553 that require the patient to be present.

This guideline outlines what you can do to substantiate that a specific treatment or action was performed as part of the requirements for Medicare Benefits Schedule (MBS) items e.g. 10960, 13757, 30189, 47600 and 85533.

This guideline relates to the MBS item numbers 80000 to 80170, rendered by allied health professionals under the Better Access program.

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 individual Allied Health services were provided for Medicare Benefits Schedule (MBS) items 10950 to 10970.

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

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) 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).

Our Corporate Plan outlines how we will deliver the health system for all Australians throughout 2025–26.