Audits
We conduct compliance audits and reviews for the MBS, PBS, CDBS and incentive programs. If we have reasonable concerns about your Medicare claiming, we may issue a notice asking you to produce relevant documents to substantiate your Medicare claims. We will raise a debt for the service if: 1. you don't provide the documents we asked for 2. the docu.
Behavioural Insights and Interventions
We use our knowledge of behaviour to improve compliance through: 1. finding behaviours of concern and what might influence that behaviour, then removing the barriers to its change 2. developing interventions based on research and behavioural science 3. using robust evaluation, such as randomised controlled trials, to decide whether interventions ar.
Case Referral to The Professional Services Review
If, after we finalise a review, we believe the 80/20 or 30/20 rulemay have been breached, or we still can’t be sure that inappropriate practice has not occurred, we refer cases to the Professional Services Review (PSR) for an independent professional review. The PSR’s peer review processes ensure that appropriately qualified people decide whether y.
Data Matching
We do routine data matching of health practitioners’ MBS and PBS claiming data to find possible incorrect billing, inappropriate practice and fraud. When working with practitioners’ data, we: 1. transfer it securely 2. match it in secure environments 3. apply strict security controls 4. only allow authorised staff to access it when required for the.
Education and Support
We provide educational resources and personal support to help you meet your legal obligations as a health practitioner and reduce the risk of incorrect billing under Medicare. This includes: 1. the introduction to compliance within MedicareeLearning module, which shows how you can meet your obligations 2. the Medicare billing complianceeLearning mo.
Practitioner Review Program Reviews
The Practitioner Review Programidentifies potential inappropriate practice by health practitioners who bill, claim or prescribe under the MBS, CDBS and PBS. Through routine monitoring of Medicare billing and prescribing, we identify health practitioners whose patterns: 1. vary significantly from those of their peers, which might indicate inappropri.
We provide educational resources and personal support to help you meet your legal obligations as a health practitioner and reduc…
