Summary of useful links
The RACGP has compiled links to information about the Medicare Benefits Schedule (MBS) and Medicare compliance so you can easily access these from one central location.
This page includes Department of Health and Aged Care, Services Australia and RACGP resources. Links are grouped under key themes, which are in alphabetical order. We’ve also included short descriptions of each resource to help you find what you need.
Resources on this page include MBS explanatory notes, education guides, fact sheets, eLearning programs and infographics. We encourage you to bookmark this page for easy reference. If you identify that any links on this page aren’t working or are no longer available, please let us know by emailing healthreform@racgp.org.au.
MBS Note AN.0.19 – After-hours attendances
- Outlines claiming requirements for the following MBS items: 585, 588, 591, 594, 599, 600, 5000, 5003, 5010, 5020, 5023, 5028, 5040, 5043, 5049, 5060, 5063, 5067, 5200, 5203, 5207, 5208, 5220, 5223, 5227, 5228, 5260, 5263, 5265 and 5267.
MBS Note AN.0.9 – Attendances by GPs
- Outlines claiming requirements for the following MBS items: 3-4, 23-24, 36-37, 44, 47, 193, 195, 197, 199, 585, 594, 599, 2497-2559, 5000-5067 and 90020-90051.
MBS Note AN.35.1 – Flag fall amount for RACF attendance by a GP
- Outlines claiming requirements for MBS item 90001.
RACF MBS attendance items
- A list of MBS items for services provided in residential aged care facilities.
MBS Online news
- A collection of news updates on changes to the MBS.
MBS Online fact sheets
- A collection of fact sheets on changes to the MBS.
MBS Review Advisory Committee (MRAC)
- The MBS Review Advisory Committee supports the MBS Continuous Review to ensure the MBS is contemporary, sustainable, evidence-based, and supports universal access to high-value care for all Australians.
About Medicare compliance
- This page provides an overview of what Medicare compliance is and why it’s important, the costs and impacts of non-compliance, who is involved in Medicare compliance, and how to report suspected non-compliance.
When Medicare compliance applies
- This page provides an overview of who must comply with Medicare obligations, and programs and payments covered by Medicare compliance.
How to comply with Medicare obligations
- This page contains links to education and support to help you meet your compliance obligations.
Medicare compliance activities
- An overview of compliance activities undertaken by the Department of Health and Aged Care.
Voluntary acknowledgement of incorrect payments
- If you think you’ve incorrectly claimed a Medicare or practice incentive payment, you must let the Department of Health and Aged Care know as soon as you can.
- You can do this by submitting a voluntary acknowledgement of incorrect payments form.
Online Compliance Platform (OCP)
- This page contains information about the OCP, including links to FAQs and supporting resources.
- The OCP is a secure digital portal for health providers. If you are contacted by the Department of Health and Aged Care about certain Medicare compliance activities, they may also invite you to use the OCP. You can use it to self-review your Medicare claims, identify any potential errors and respond to the Department online.
Non-compliance debts and penalties
- You must repay any incorrect payments made to you under Medicare.
- You might also have to pay additional penalties. How you work with the Department of Health and Aged Care can decrease or increase any penalty amount.
Shared Debt Recovery Scheme
- Under the Shared Debt Recovery Scheme, a debt can be split between the practitioner and the person who manages their billing and claiming.
Reporting incorrect billing, claiming, or suspected fraud
- Information on how to submit a tip-off in relation to billing by a healthcare professional.
Audits
MBS audit process
- A fact sheet describing the Medicare audit process.
Application to review a compliance audit decision
- Use this form to request a review of decision of a compliance audit under subsection 129AAJ(1) of the Health Insurance Act 1973.
Practitioner Review Program
Practitioner Review Program
- An overview of the Practitioner Review Program (PRP), including what constitutes inappropriate practice and how reviews are conducted.
What you need to know
- Information about the purpose of the PRP, how inappropriate practice is identified, how a PRP case is conducted, and participating in the PRP process.
The interview
- Information about the PRP interview process.
The six-month review
- Information about the PRP six-month period of review, which may be offered if some or all identified concerns remain after the interview.
Referral to the delegate without a six-month review
- Information about the PRP where practitioners are referred to a delegate of the Chief Executive Medicare after an interview without a six-month period of review.
Delegate assessment
- Information about the PRP and the review by a delegate of the Chief Executive Medicare.
Frequently asked questions
- Frequently asked questions about the PRP.
Preparing a written submission for the Practitioner Review Program
- As part of the PRP, you may be given an opportunity to provide a written submission or additional information relating to concerns about your claiming or prescribing.
A guide for those who employ or engage practitioners
- A guide to practitioner reviews for persons who employ or otherwise engage practitioners.
Professional Services Review
Guide to the PSR process
- This guide outlines in detail the stages in the PSR process for those who are referred to the PSR.
Professional Services Review website
- The PSR agency administers the PSR Scheme to investigate Medicare-referred cases of possible inappropriate practice relating to Medicare, the CDBS and the PBS.
PSR monthly case outcome reports
- Throughout the year, the PSR publishes monthly reports of case outcomes.
- All matters referred to the PSR are treated on their merits and with consideration of individual circumstances.
- These summaries of outcomes, reported in the interests of transparency, are not indicative of a likely outcome in any particular case.
80/20 and 30/20 rules
Prescribed pattern of services – The 80/20 and 30/20 rules
- A collection of information for practitioners about the prescribed pattern of services (the 80/20 and 30/20 rules).
30/20 telephone rule
- Information on the prescribed pattern of service 30/20 telephone rule, including relevant telephone attendance services. The rule was introduced on 1 October 2022.
What you need to know
- Information about inappropriate practice and prescribed pattern of services (the 80/20 and 30/20 rules) and which professional attendance services apply.
How are breaches detected and what happens next?
- 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.
Exceptional circumstances
- Information on legislative requirements and considerations when there is a breach of the prescribed pattern of services (the 80/20 and 30/20 rules).
Inappropriate practice
Inappropriate practice
- Information on the definition of inappropriate practice and how it applies to practitioners and corporate entities.
The Department of Health and Aged Care’s role in identifying potential inappropriate practice
- Information on the Department’s role in identifying and intervening with practitioners and corporate entities where potential inappropriate is found.
Common compliance issues associated with findings of inappropriate practice
- Information on the common compliance issues associated with inappropriate practice based on Professional Services Review outcomes.
What can I do to avoid practising inappropriately?
- Information on how to avoid practicing inappropriately, your responsibilities and sources of information to meet Medicare requirements.
MBS Note TN.8.125 – Removal of skin lesions – Necessary excision diameter
- Outlines claiming requirements for MBS items 31356 to 31383.
MBS Note TN.8.22 – Removal of skin lesions
- Outlines claiming requirements for MBS items 31356 to 31383.
MBS Note TN.8.23 – Removal of skin lesions from face
- Outlines claiming requirements for MBS items 31245, 31361-31364, 31372, 31373, 31379 and 31380.
MBS Note TN.8.6 – Repair of wound
- Outlines claiming requirements for MBS items 30023 to 30049.
Education guide – Billing skin lesion treatment and biopsy items under Medicare
- A guide to billing skin biopsy, skin lesion treatment and skin flap MBS items.
eLearning programs
Consultation items and the treatment of skin lesions
- This module provides guidance on the appropriate billing of MBS attendance items for assessment and/or treatment of skin lesions.
- It outlines instances where an attendance item can be claimed in addition to an MBS procedural item for the treatment of skin lesions.
Skin lesion excision and local flap repair
- This module provides guidance on the appropriate billing of skin lesion excisions.
- It also contains information on performing local skin flap repair, seeking confirmation of clinically suspected melanoma, and follow-up excision where melanoma is confirmed.
Treatment of skin lesions other than excision
- This module includes extracts from MBS explanatory notes to help you understand the requirements for the treatment of skin lesions, other than by excision.
Treatment of skin lesions – Case studies and knowledge checks
- This module provides case studies and knowledge checks relating to:
- plantar warts, solar keratoses, multiple warts and solar skin disease
- the appropriate billing of skin lesion excisions
- situations where an attendance item only can be claimed.
Infographics
Determining lesion size
Malignant melanoma skin lesions
Non-malignant skin lesions
Malignant skin lesions
Mohs micrographic surgery
Removal of tumours, cysts, ulcers or scars
Skin flaps
Skin lesion excision and flap repair item restrictions
Types of skin defects
Wound repair
Suspected melanoma skin lesions
MBS Note AN.36.1 – General explanatory notes
- Outlines claiming requirements for MBS items 90250-90257, 90260-90267, 90271-90278, 92182, 92184, 92186, 92188, 92194, 92196, 92198 and 92200.
MBS Note AN.36.2 – Eating disorder treatment and management plans
- Outlines claiming requirements for MBS items 90250-90257 and 90260-90263.
MBS Note AN.36.4 – Eating disorder psychological treatment services
- Outlines claiming requirements for MBS items 90271-90278, 92182, 92184, 92186, 92188, 92194, 92196, 92198 and 92200.
Education guide – Eating disorder treatment and management plans
- Information for medical practitioners about eating disorder treatment and management plans.
eLearning program – Eating disorder treatment and management plans
- This module provides information for medical practitioners and allied health professionals about eating disorder treatment and management plans.
- You’ll learn about eligible conditions and eligibility criteria, and referrals for psychological and dietetic treatment services.
Infographic – Eating disorder treatment and management plans
- A flowchart outlining review and referral pathways for patients with eating disorder plans.
Infographic – Eligibility for treatment services under an eating disorder plan
- A flowchart outlining patient eligibility for treatment services under an eating disorder plan.
MBS Note AN.0.9 – Attendances by GPs
- Outlines claiming requirements for MBS items 3-4, 23-24, 36-37, 44, 47, 193, 195, 197, 199, 585, 594, 599, 2497-2559, 5000-5067 and 90020-90051.
Inclusion of communication time when claiming time-tiered MBS items
- This fact sheet provides information on how to account for time taken to communicate with patients (eg those who require an interpreter) when claiming time-tiered MBS items.
Understanding Medicare: Provider Handbook
- This handbook is a plain English guide that details the fundamental elements and principles of Medicare. It provides core guidance for healthcare professionals and others navigating the Medicare system.
Start with Medicare
- Information about starting with Medicare as a health professional, including claiming benefits and applying for a provider number.
Accessing Medicare for health practitioners and industry
- Health practitioners must meet certain requirements to bill MBS items under Medicare or prescribe subsidised medicines.
What Medicare covers
- This page provides information on what is and isn’t covered under Medicare, and support available through other programs.
MBS Online
- MBS Online (www.mbsonline.gov.au) is the central hub for information about MBS items. You can search for item numbers and view descriptors and explanatory notes.
- The website also contains news on major changes to the MBS and fact sheets with further information.
Subscribe to receive MBS updates
- Subscribe here to receive MBS Online update emails.
AskMBS email advice service
- This fact sheet provides an overview of the AskMBS email advice service. This advice assists health professionals, practice managers and others to understand and comply with MBS billing requirements.
AskMBS advisories
- This collection of AskMBS advisories will help health professionals, practice managers and others to understand and comply with MBS billing requirements.
AskMBS Advisory #1 – General practice services
AskMBS Advisory #2 – General practice services
- Advice for health providers and other users of the MBS on the interpretation and application of MBS items, explanatory notes and associated legislation, to assist them in billing Medicare correctly.
Services Australia eLearning programs – Medicare for health professionals
- A collection of modules that provide an introduction to Medicare.
The Australian healthcare system
- This module will provide you with an understanding of the Australian healthcare system and what Medicare covers.
The Medicare program
- This module will provide you with an understanding of patient eligibility, the importance of a Medicare card, and how to read the details on a Medicare card.
Provider and prescriber number eligibility
- This module provides an overview of health professional eligibility and how to apply for a provider or prescriber number from Medicare.
Introduction to the MBS
- Item numbers, descriptors, explanatory notes – what do these terms mean? How will knowing about them help you in your everyday work? Find the answers to these questions and more in this module.
Referrals and requests
- This module explains the difference between referrals and requests, and outlines what constitutes a valid referral for MBS item billing purposes.
Medicare billing and claiming basics
- This module explains generic aspects of patient billing and the different claiming and payment options.
Attendance basics
- This module provides an overview of MBS primary care items and focuses on selecting appropriate attendance items based on characteristics of the attendance.
Education guide – Medicare reason codes and reducing claim rejections
- This guide provides an overview of Medicare reason codes used when services are rejected in claims lodged for Medicare benefits.
Bulk bill payments to health professionals
- Information to help you with Medicare bulk billing. Topics covered include assignment of benefit, additional charges and bulk billing, bulk billing and private billing together, and claiming bulk bill payments.
Strategies to minimise risk
- There are 10 strategies you should adopt in your practice to identify, manage and prevent the risk of incorrect billing under Medicare.
Step-by-step guide
- The five steps in the toolkit make up a continuous improvement cycle for your practice’s Medicare billing assurance approach.
Pre-participation questionnaire
- Encourage health professionals in your practice to complete the following questionnaire before undertaking a Medicare billing assurance review of your practice. You can track perceptions and attitudes and identity trends to focus on.
Post-participation questionnaire
- Encourage health professionals in your practice to complete this questionnaire after undertaking a Medicare billing assurance review. You can use the responses to track perceptions and attitudes in your practice and identity areas to focus on.
Record keeping tips
- These 10 simple tips will help you establish and maintain an effective administrative record keeping system.
Medicare billing assurance template
- This template is intended to assist practices to develop a customised Medicare billing assurance manual. It contains examples of policy statements and operational guidance.
Medicare billing assurance charter
- This Medicare billing assurance charter sets out the principles that support billing activities under Medicare.
Medicare billing assurance manual template
- This template helps practices develop a Medicare billing assurance manual. The manual can be customised to suit the particular requirements of each practice. It contains examples of policy statements and operational guidance which can create a Medicare billing assurance approach.
MBS Note AN.0.56 – GP Mental Health Treatment items
- Outlines claiming requirements for MBS items 2700, 2701, 2712, 2713, 2715 and 2717, and is also applicable for video and phone equivalent MBS items 92112, 92113, 92114, 92115, 92116, 92117, 92126 and 92127.
MBS Note AN.0.78 – Better Access Initiative
- Provides an overview of the Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule Initiative (Better Access).
MBS Note MN.7.4 – Provision of Focussed Psychological Strategies
- Outlines claiming requirements for MBS items 2721, 2723, 2725, 2727, 91818, 91819, 91842 and 91843.
MBS Note MN.6.3 – Referral requirements for Better Access treatment services
- Outlines referral requirements for Better Access treatment services, including psychological therapy services and focussed psychological strategies.
MBS Note AN.15.1 – Mental health case conferences
- Outlines claiming requirements for MBS items 930, 933, 935, 937, 943 and 945.
MBS Note MN.7.5 – Family and carer participation
- Outlines claiming requirements for MBS items 2739, 2741, 2743, 2745, 91859, 91861, 91864 and 91865.
Better Access initiative – Department of Health and Aged Care website
- The Better Access initiative gives Medicare rebates to help people access mental health professionals and care, regardless of where they live. Find out how the initiative works, who is eligible and how people can access supports.
Better Access initiative – Services Australia website
- Information about services eligible health professionals can provide to patients under the Better Access initiative.
Frequently asked questions on MBS mental health items – General Practice Mental Health Standards Collaboration (GPMHSC) website
- Find out more about MBS item numbers used for the provision of primary mental healthcare. This page includes common questions and answers obtained from various sources, such as the Australian Psychological Society (APS) and the Department of Health and Aged Care.
eLearning program – Access to mental health services for eligible medical practitioners
- This module provides information about the Better Access to Psychiatrists, Psychologists and General Practitioners (Better Access) initiative in the MBS.
Infographic – Better Access mental health treatment referred allied health services
- A flowchart outlining pathways for patients accessing allied health services under the Better Access initiative.
Medicare Benefits Schedule online tool
- This tool allows RACGP members to enter fees for services they provide. The tool will calculate the patient out-of-pocket amount based on the Medicare rebate. Users can also create custom lists of items they use in their practice. You will need to log in to the RACGP website to access this resource.
Updates on major changes to the MBS affecting GPs
- This page provides updates on major changes to the MBS affecting GPs, such as the introduction of new item numbers.
Statement on Medicare interpretation and compliance
- This statement outlines the RACGP’s position on Medicare interpretation and compliance processes. You will need to log in to the RACGP website to view this page.
On-demand webinar – Improving your understanding of the MBS
- This webinar provides an overview of how to improve your understanding of the MBS. The session covers:
- resources available to support MBS use and interpretation
- how to ensure your use of the MBS is compliant
- understanding your billing profile – how to find information about your billing profile from common practice software systems
- RACGP resources to assist with MBS use (eg MBS online tool).
Q&A – Improving your understanding of the MBS
- This document provides written responses to questions asked by attendees at the above webinar.
Q&A – Demystifying Medicare
- This document provides written responses to questions asked by attendees at the Demystifying Medicare session held at the RACGP’s 2023 Practice Owners National Conference. This session was presented by Dr Robert Menz and Brett McPherson.
On-demand webinar – Unpacking the Medicare compliance process
- This webinar is a joint presentation between the Department of Health and Aged Care and the Professional Services Review on the Medicare compliance process. It aims to alleviate some of the fear and misconceptions that exist around compliance.
Q&A – Unpacking the Medicare compliance process
- This document provides written responses to questions asked by attendees at the above webinar.
Medicare compliance FAQs
- Frequently asked questions on the Medicare compliance process, designed to help GPs better understand the different types of compliance activities and alleviate some of the fear and misconceptions that currently exist.
Supports available
The RACGP provides a support program for members who are experiencing stress or similar difficulties due to compliance measures.
GP Support Program
Self-care and mental health resources
MBS Note GN.7.17 – Billing procedures
- Where a practitioner provides a number of services (excluding operations) on the one occasion, they can choose to bulk bill some or all of those services and privately charge a fee for the other services, in excess of the Medicare rebate.
- This note contains more information on the rules pertaining to split billing.
Bulk billing and private billing together
- Information on the Services Australia website about split billing.