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New PIP Indigenous Health Incentive

A new Practice Incentives Program (PIP) Indigenous Health Incentive, costing $28 million over four years, will start in May 2010.

The PIP Indigenous Health Incentive will target Aboriginal and Torres Strait Islander patients aged 15 years and over with chronic disease and is part of the Council of Australian Governments (COAG) National Partnership Agreement on Closing the Gap: Tackling Indigenous Chronic Disease.

The PIP Indigenous Health Incentive will support general practices and Indigenous health services to provide better health care for Indigenous Australians, including best practice management of chronic disease. The first payments through the Indigenous Health Incentive will be made to eligible PIP practices in May 2010.

HPOS Phase 2—December update

The Health Professional Online Services (HPOS) December release offers improved online services to help make it easier for you to do business with us.

These services include:

• the ability to view a patient's care plan history (with consent) at the time of consultation
• allow practice staff who have a PKI individual certificate to undertake administrative tasks on behalf of health professionals
• an expansion of the existing email subscription facility to include National Bowel Cancer Screening Program statements
• the ability for health professionals to view their access history
• the inclusion of My Favourites in the navigation menu
• helpdesk support.

To access the full range of HPOS information and services, you need a PKI individual certificate.

For more information about HPOS and to register for PKI go to HPOS.

National Compliance Program 2009–2010 is now available

The National Compliance Program 2009–2010 focuses on Medicare Australia’s key stakeholder groups. It highlights areas of concern with compliance, outlines responses to these concerns and how Medicare Australia will support each group to voluntarily comply.

For more information, see National Compliance Program 2009-2010

Online education services—refresh your knowledge online in just a few easy clicks

Medicare Australia’s online education services offer you increased access to nationally consistent learning and support—whether you are a new health professional, or established in your practice.

Available 24 hours a day, seven days a week, online education services provide an easy to use and convenient way to refresh your knowledge of Medicare and PBS requirements.

Online education services are updated regularly, so make sure you bookmark our website to check for updates and new content.

For more information, visit online education services as they are already on the Medicare site.

Budget 2009–10

On Tuesday 12 May 2009 Treasurer, The Hon. Wayne Swan MP, delivered the Federal Budget for 2009–10. Of the budget measures announced, a number affect Medicare Australia through new initiatives and changes to existing policies.

Medicare Australia specific measures

Fraud and compliance program—matching of MBS and PBS data

This measure will enable Medicare Australia to match Medicare Benefits Schedule and Pharmaceutical Benefits Schedule claims data to allow systematic data matching and profiling for compliance purposes.

Medicare Australia will use the information to investigate compliance, fraud and debt recovery inline with current processes.

Medicare Australia—additional offices

As part of the Federal Budget, funding has been approved for three new Medicare offices. The Australian Government has committed $7.0 million over four years to deliver better Medicare services. Where possible the new offices will be co-located with existing Centrelink Service Centres to provide easy access to Medicare services for local residents, in line with the Service Delivery Reform agenda.

New Medicare offices:

• Belmont, Western Australia
• Belmont, New South Wales
• Warrawong, New South Wales (using the existing Centrelink Service Centre in King Street Shopping Centre until a purpose built co-location facility is completed in 2010-11).

Further information on Budget measures announced can be found on the following websites.

• Budget 2009-10
• Department of Human Services  
• Department of Health and Ageing
• Department of Families, Housing, Community Services and Indigenous Affairs
• Department of Immigration and Citizenship

HPOS Phase 2—making it easier for you

Phase 2 of the Health Professional Online Services (HPOS) will be implemented in three releases, starting in September 2009.

Some of the new services include:

• an online tool allowing you to find out your eligibility for Medicare incentives
• useful links
• Medicare Australia’s online education eLearning tools.

To access the full range of HPOS information and services, you need a PKI individual certificate.

For more information about HPOS and to register for PKI visit HPOS.

Increased Medicare compliance audit initiative

As part of the 2008-09 Federal Budget, the government announced an increase in Medicare Australia’s Medicare Benefits Schedule (MBS) compliance activities and proposed amendments to Medicare Australia’s audit powers.

As part of the initiative, an additional 2000 MBS compliance audits will be carried out each financial year from 1 January 2009. This will increase Medicare Australia’s audit coverage to nearly 3 per cent of the provider population, compared to current audit coverage of less than 1 per cent.

The government also announced that it will introduce legislation to:

• create an obligation on providers to produce records substantiating their MBS claims
• establish new financial penalties for providers who have claimed MBS items incorrectly.

The Department of Health and Ageing (DoHA) and Medicare Australia have produced two information sheets following meetings with organisations representing providers, consumers and privacy groups.                              

These information sheets provide more information about how the proposed legislation changes will operate, and responds to common questions from peak bodies. The information sheets outline:

• how providers are selected for MBS compliance audits
• why the changes to the audit process are being made
• what the Government is doing to help providers comply.

Increased Medicare Compliance Audits information sheet [PDF, 131Kb]

The increased MBS compliance audits initiative information sheet [PDF, 319Kb]

On 19 March 2009 the former Minister for Human Services, Senator the Hon Joe Ludwig moved a motion in the Senate to refer draft legislation to the Senate Standing Committee on Community Affairs for inquiry.

Medicare Australia provided a written submission to the Senate Committee in response to the inquiry into compliance audits on Medicare benefits. On 6 May 2009, Medicare Australia and various stakeholders appeared before the Senate Committee in order to provide evidence.

On 17 June 2009, the report of the Senate Committee was publicly released. The report outlines the inquiry and the conclusions. 

New provider percentile charts

New Provider percentile charts show the number of services billed by peer groups for selected MBS items. You can use these charts to compare your billing data with your peers.

Changes to legislation affecting the PBS

• Legislation update [PDF, 140Kb]

Changes to legislation will give your customers greater access to affordable medicine through the PBS and the PBS Safety Net.

These changes include:

• Safety Net—equal treatment for same sex couples (as part of broader legislative changes relating to same sex couples)
• Safety Net—couples separated by illness
• PBS—government officers working outside Australia.

 PBS Safety Net—equal treatment for same sex couples

From 1 January 2009, PBS Safety Net families can include same sex de facto couples and their dependants, providing the same access to PBS Safety Net benefits for all couples, regardless of gender. The same Safety Net rules will apply for these families and they will be eligible for the same thresholds and concessions.

To be included as part of a Safety Net family, a couple must be living together on a permanent basis, unless living separately due to illness (see below).

 PBS Safety Net—couples separated by illness

From 1 January 2009, married and de facto couples living separately due to illness, infirmity or frailty (for example, for nursing care, residential or Aged Care) can access PBS Safety Net benefits jointly as a family, as if they were living together.

 PBS—government officers working outside Australia

Up until recently, it has been illegal for you to supply PBS medicine for a person who is not in Australia at the time of supply, and for PBS medicine to be sent overseas for another person.

Changes to the legislation mean you can now dispense PBS prescriptions for Commonwealth, state or territory government officers working overseas, and for their accompanying partners and dependants. The medicine can be sent out of Australia for use by these officers and their families. Safety Net benefits and entitlements apply.

Before dispensing, check:

• you are satisfied the person is eligible for PBS access—information from the officer’s government agency or department can be used for this purpose
• the Medicare card number or Veterans’ Affairs entitlement number is valid.

More information

Department of Health and Ageing Website

Call Department of Health and Ageing PBS Information Line 1800 020 613*

Email

* Call charges apply from mobile and pay phones only.

Increased Medicare compliance audit initiative

As part of the 2008-09 Federal Budget, the government announced an increase in Medicare Australia’s compliance activities and some amendments to Medicare Australia’s audit powers.

As part of the initiative, an additional 2000 MBS compliance audits will be carried out each financial year, starting in January 2009. This will increase Medicare Australia’s audit coverage to about 4 per cent of the provider population, compared to current audit coverage of less than 1 per cent.

The government also announced that it will:

• introduce legislation to create an obligation on providers to produce records substantiating their MBS claims
• establish new financial penalties for providers who have claimed MBS items incorrectly.

In conjunction with the Department of Health and Ageing, Medicare Australia has recently circulated an information sheet to key stakeholders. The information sheet provides further information on the increased MBS compliance initiative and invites public submissions on some of the details.

For more information, download the Increased MBS Compliance Audits information sheet [PDF, 131Kb]

Medicare Teen Dental Plan and Medicare chronic disease dental scheme

On 1 July 2008, the Australian Government introduced the Medicare Teen Dental Plan to help with the cost of an annual preventative dental check for eligible teenagers.

• Medicare Teen Dental Plan
• Medicare Teen Dental Plan forms for dentists

The Medicare chronic disease dental scheme was introduced in November 2007. The scheme allows chronically ill people who are being managed by their GP under an Enhanced Primary Care (EPC) plan access to Medicare rebates for dental services.

• Medicare chronic disease dental scheme
• Medicare chronic disease dental scheme forms for dentists
• Referral forms for GPs – Medicare chronic disease dental scheme are available on the Department of Health and Ageing website or by faxing a request to (02) 6289 7120.

For more information

Call Medicare Australia on 132 150 or visit the Department of Health and Ageing website at www.health.gov.au/dental

Online Medicare eLearning for Dentists

An eLearning program has been developed to support dentists who are new to billing Medicare. The program is interactive and easy to use. Modules include 'What is Medicare?' and 'Billing and Claiming.' The program takes approximately 45 minutes to complete.

New laws on inducements for pathology and diagnostic imaging effective 1 March 2008

There have been changes to the legislation around inducements for pathology and diagnostic imaging referrals. These new laws are effective from 1 March 2008. They apply to any existing arrangements as well as any new arrangements put into place after 1 March 2008.

For more information visit Pathology Services on the Department of Health and Ageing website or call 132 150.

The Department of Health and Ageing has consulted with pathology, diagnostic imaging and medical organisations about the development of regulations. The regulations provide extra detail on some aspects of the legislation.

Further consultation is currently underway. If you have any comments or need more information, please contact the Department of Health and Ageing at legislativeamendments@health.gov.au.

If you are unsure how the changes will affect you, please seek legal advice.

Financial assistance for switching on electronic claiming

If you’ve recently switched on Medicare Easyclaim, Medicare Online or ECLIPSE, you may be eligible for financial assistance. More information about Medicare Australia’s Transitional Support Package can be found on the Claiming choices page

Some documents on this page may require the free Adobe PDF reader.

Last updated: 14 December, 2009