Professional Services Review Annual Report 2015-16

by | Nov 3, 2016 | Health Blog

The Professional Services Review Agency has released its Annual Report for the 2015-16 financial year, outlining some of the main focuses of the Medicare Benefits Scheme (MBS) watchdog.

In 2015/16 there was an increase in the number of investigations of Chronic Disease Management and MBS Health Assessment items. Many practitioners providing high numbers of these services were found to use computer-generated templates leading to plans with minimal content specific to the patient for whom it had been prepared. Further, some team care arrangement plans were made without discussion with allied health professionals, and some management plans were prepared for 12 months without the requisite 3 monthly review.

The 80/20 rule also remained a focus of investigation. Under MBS regulations, a GP is deemed to have engaged in inappropriate practice if, on each of 20 days in the previous year, they billed Medicare for at least 80 MBS Attendance items. All the attendances provided on 80/20 days are deemed to be inappropriate practice, and the GP is liable for repayment of all MBS benefits for these services.

According to the annual report a typical 80/20 GP provides around 17,000-20,000 services, leading to gross Medicare rebates of around $800,000-$1,000,000. These doctors were offering “diverse explanations” for their billing, including that they worked long hours, they knew their patients well and could see them quickly, and also that they had developed “efficient processes” with nurses providing chronic disease management.

The PSR said the MBS rebates inappropriately claimed by the 80/20 doctors ranged between $100,000 and $350,000.

Urgent after-hours services were another area of concern during 2015-16 with practitioners claiming for urgent treatment in situations involving non-urgent care including uncomplicated rash, reissuing of medication, and routine completion of medication charts in aged care facilities.

The watchdog said it had struck 18 negotiated agreements with practitioners involving the repayment of $1.6 million, and 12 doctors had been partially disqualified from claiming Medicare rebates.

To read more about the Professional Services Review Annual Report for 2015-16, click here.

To read the Medicare Benefits Schedule and ensure that you are billing accurately, click here.

Emma Jack

Emma Jack