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20 Sep 2018

AMA members are advised that they may be affected by recent changes to the Health Insurance Act 1973. One key change is that from 1 July 2018 medical practitioners are required to keep a copy of any document created as a condition of claiming a Medicare Benefits Schedule (MBS) Item for two years from the date of the professional service.

For GPs, examples of such documents include:

  • GP Chronic Disease Management Plan (required to be created under MBS item 721).
  • GP Mental Health Plan (required to be created under MBS items 2700, 2701, 2715 or 2717).

Other key changes to the Act include:

  • The department can issue a Notice to Produce as part of a compliance activity, which requires you to produce documents relating to items claimed. Before issuing the Notice, the department must first provide an opportunity for you to respond to compliance concerns and provide substantiation of claims.
  • Financial Administrative Penalties can be applied to a debt of more than $2,500 if substantiating documents are not provided, or not provided within the required timeframe.
  • Improved debt recovery mechanisms that allow the department to offset or deduct a debt owed from amounts payable to the debtor or to garnishee debts from a debtor’s bank account.
  • From 1 July 2019 the Shared Debt Recovery Scheme will commence and will allow the Department to hold an employing organization responsible for a portion of debts incurred as a result of incorrect Medicare claiming. The one year delay in the Scheme’s introduction allows for consultation with peak bodies to generate Regulations under which the Scheme will operate.
  • To assist in this, information about a health professional’s employer or contracting organisation will now be required when applying for a provider number.

The AMA encourages all GPs, and particularly practice principals, to familiarise themselves with the changes.

For more information, visit www.health.gov.au/health-compliance or email compliance.stakeholder@health.gov.au


Published: 20 Sep 2018