Resources

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.

This guideline outlines what you can do to substantiate histopathological proof of malignancy for Medicare Benefits Schedule (MBS) items 30196, 30197, 30202, 30203 and 30205.

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

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

This fact sheet provides advice on preparing a submission.

Frequently asked questions about the Practitioner Review Program.

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.

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

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 optometry services for Medicare Benefits Schedule (MBS) items 10912, 10913, 10914, 10915, 10942 and 10943.

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

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.

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.

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.

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

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

From 1 November 2025, under the Aged Care Act 2024 (the new Act), registered providers will have to meet certain conditions of registration, obligations and statutory duties when delivering funded aged care services.

The Aged Care Act 2024 (the new Act) sets out a condition of registration for registered aged care providers delivering meals, snacks and drinks to an older person’s home or as part of community, centre-based and cottage respite

The new Aged Care Act starts from 1 November 2025 and will help to make aged care better for Aboriginal and Torres Strait Islander people.

This document provides answers to some frequently asked questions raised during the Commonwealth Home Support Program sector readiness webinar held on 12 June 2025.

The guide to digital changes for providers outlines the key digital changes that providers will experience in the lead up to the implementation of the new Act on 1 November 2025. It provides information to assist providers to anticipate and prepare for changes.

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.

This publication includes data about Community Pharmacy Programs funded under the Eighth Community Pharmacy Agreement (8CPA).