×
We're aware of a cyber security incident affecting the electronic prescriptions provider MediSecure. The eRX Script Exchange (eRX) and the National Prescription Delivery Service (NPDS) continue to operate as usual and have not been impacted. Find out more and read our statement here.

Medicare Benefits Schedule / Medicare compliance - Summary of useful links


Last updated 5 April 2024

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.

 


Education guide – Aftercare or post-operative treatment

  • This guide contains information about aftercare in the MBS. Aftercare is the post-operative care and treatment provided to patients after an operation.
eLearning program – Aftercare or post-operative treatment
  • This module contains information about aftercare in the MBS.
  • By the end of this module you’ll be able to:
    • understand what aftercare or post-operative treatment is
    • identify when you can and can’t charge an MBS attendance item following a procedure
    • identify the requirements of aftercare.
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.
Relative Value Guide for anaesthesia billing
  • Contains information on billing Medicare items for Relative Value Guide services.
  • Medicare benefits for anaesthesia services are calculated using the Relative Value Guide (RVG). The RVG is based on a unit system. It reflects the complexity and time taken for the service.
eLearning program – Anaesthesia billing requirements
  • This module explains the key requirements to claim Medicare benefits for anaesthesia services.
  • After completing this module, you’ll have a better understanding of account and billing matters relating to the Relative Value Guide.
Infographic – Relative Value Guide for anaesthesia order of services billing
  • A table listing the correct order to bill anaesthesia items.
Assignment of benefit and signature requirements for telehealth services
  • Updated advice on assignment of benefit requirements for bulk billed telehealth services from 21 September 2023, available on the Services Australia website.
Verbal assignment of benefit arrangements for telehealth services
  • Fact sheet available on MBS Online.
DB4E assignment of benefit form
  • Use this form to claim assigned benefits for electronically transmitted claims.
  • These services can be claimed through HPOS Bulk Bill Webclaim capability.
DB020 assignment of benefit form
  • This form should be used in conjunction with Medicare Bulk Bill Webclaims only.
Assignment of benefit
  • General advice on the assignment of benefit process for bulk billed services from the Services Australia website.
RACGP website – Assignment of benefit and signature requirements for MBS telehealth services
  • This page contains the latest updates on assignment of benefit requirements and the RACGP’s advocacy on this issue.
MBS Note GN.7.17 – Billing procedures
  • This note outlines the rules pertaining to bulk billing and raising additional charges.
Additional charges and bulk billing
  • Information about additional charges and bulk billing on the Services Australia website.
Fact sheet – Medicare bulk billing and additional charges
  • This educational resource provides information on the Medicare requirements for bulk billing and the charging of additional fees to patients.
MBS Note MN.1.1 – Bulk billing incentives
  • Outlines claiming requirements for MBS bulk billing incentive items.
MBS Note MN.1.3
  • Bulk billing incentives for eligible patients in Modified Monash Area 1.
MBS Note MN.1.4
  • Bulk billing incentives for eligible patients in Modified Monash Area 2.
MBS Note MN.1.5
  • Bulk billing incentives for eligible patients in Modified Monash Area 3 and 4.
MBS Note MN.1.6
  • Bulk billing incentives for eligible patients in Modified Monash Area 5.
MBS Note MN.1.7
  • Bulk billing incentives for eligible patients in Modified Monash Area 6.
MBS Note MN.1.8
  • Bulk billing incentives for eligible patients in Modified Monash Area 7.
Education guide – Claiming bulk bill incentive items
  • This guide contains information about basic eligibility for claiming bulk bill incentive payments.
eLearning program – Bulk bill incentive items
  • This module outlines bulk bill incentive items that are available to medical practitioners.
  • By the end of this module you’ll be able to:
    • identify when you can and can’t charge an MBS bulk bill incentive item
    • have an understanding of billing multiple incentives.
Bulk billing in general practice from 1 November 2023
  • This page provides information on the 1 November 2023 changes to MBS bulk billing incentive payments in general practice, including new tripled bulk billing incentive items.
RACGP fact sheet – Bulk billing incentives since 1 November 2023
  • This fact sheet covers general eligibility for BBIs, tripled BBI item numbers by level of remoteness and eligible services, standard BBIs (pre-existing items), eligibility scenarios for the new tripled BBIs, and links to further information.
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.
MBS Note AN.0.47 – Chronic disease management items
  • Outlines claiming requirements for MBS items 721 to 732.
MBS Note AN.0.49 – Multidisciplinary case conferences by GPs
  • Outlines claiming requirements for MBS items 735 to 758.
Chronic disease management patient information
  • Information for patients about chronic disease management services.
Education guide – Chronic disease GP Management Plans and Team Care Arrangements
  • Information for medical practitioners about supporting patients with chronic diseases.
Infographic – Chronic disease management GPMP referred allied health services
  • A flowchart outlining pathways for patients accessing allied health services under a GP Management Plan.
GP Management Plans
  • This module will help you understand your obligations to comply with standard work practices and maintain a sound working knowledge of MBS requirements relating to GP Management Plans.
Team Care Arrangements
  • This module will help you understand your obligations to comply with standard work practices and maintain a sound working knowledge of MBS requirements relating to Team Care Arrangements.
Targeted MBS primary care items
  • This module provides an overview of MBS items for patients with chronic conditions and complex care needs.
Multidisciplinary case conferences
  • This module provides information on how health professionals may meet to discuss, plan, coordinate or make arrangements on behalf of their patient.


GPMP case studies

The case studies below will help you to understand:

  • which patients are eligible for a GP Management Plan (GPMP)
  • the steps involved in preparing a GPMP
  • the general service limitations of these items and the circumstances where these limitations can be exceeded
  • the assistance that practice nurses, Aboriginal and Torres Strait Islander health practitioners and Aboriginal health workers can provide for GPMP services
  • the connection between a GPMP and accessing allied health services.

GPMP case study – Asthma (child)
GPMP case study – Asthma (adult)
GPMP case study – Osteoarthritis
GPMP case study – Tendonitis
GPMP case study – Psoriasis
GPMP case study – Diabetes


TCA case studies

The case studies below will help you to understand:

  • which patients are eligible for Team Care Arrangements (TCAs)
  • the steps involved in coordinating TCAs
  • the general service limitations of these items and the circumstances where these limitations can be exceeded
  • the assistance that practice nurses, Aboriginal and Torres Strait Islander health practitioners and Aboriginal health workers can provide for TCA services
  • the connection between TCAs and accessing allied health services.
TCA case study – Osteoarthritis, osteoporosis and Parkinson’s disease
TCA case study – Heart failure
TCA case study – Breast cancer
TCA case study – Chronic obstructive airways disease
TCA case study – Osteoarthritis
TCA case study – Pelvic leiomyosarcoma
TCA case study – Diabetes
Education guide – Billing multiple MBS items
  • Information for health professionals about complete medical services, billing multiple MBS items and interpreting common MBS phrases.
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.
eLearning module – Introduction to compliance within Medicare
  • This module provides an overview of the Medicare compliance program, compliance activities to protect the integrity of Medicare, and resources to help you voluntarily comply and meet your 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.
MBS Note AN.0.36 – Health assessments
  • Outlines claiming requirements for MBS items 701, 703, 705 and 707.
MBS Note AN.14.2 – Heart health assessment
  • Outlines claiming requirements for MBS item 699.
MBS Note AN.0.43 – Health assessment for Aboriginal and Torres Strait Islander people
  • Outlines claiming requirements for MBS item 715.
MBS health assessment items 701, 703, 705, 707 and 715
  • Information about health assessment items including components of a health assessment, patient consent, what is meant by the patient’s ‘usual doctor’, assistance provided by other health professionals, and claiming restrictions.
Education guide – Health assessments and your record keeping responsibilities
  • A guide to record keeping requirements when billing MBS health assessment items.
Education guide – Aboriginal and Torres Strait Islander health assessments and follow-up services
  • Information on Indigenous health assessments and follow-up services for Aboriginal and Torres Strait Islander patients.
How to access Medicare bulk bill reports in HPOS
  • This resource shows you how to access bulk bill payment and processing reports in HPOS. You will be able to view claims that have been successfully submitted and paid, and any claims processed with errors.
Accessing Medicare Easyclaim reports using HPOS
  • A guide to using HPOS to generate bulk bill processing and payment reports for Medicare Easyclaim.
Guideline for substantiating coordination of the development of Team Care Arrangements
  • This guideline outlines what you can do to substantiate the coordination of the development of Team Care Arrangements rendered by eligible medical practitioners for MBS item 723.
Guideline for substantiating preparation of a valid GP Mental Health Plan
  • This guideline outlines what you can do to substantiate the preparation of a valid GP Mental Health Treatment Plan rendered by eligible medical practitioners for MBS items 2700, 2701, 2715 and 2717.
Guideline for substantiating proof of malignancy
  • This guideline outlines what you can do to substantiate histopathological proof of malignancy for MBS items 30196, 30197, 30202, 30203 and 30205.
Guideline for substantiating services provided under rights of private practice at public hospital outpatient departments
  • This guideline outlines how you can substantiate services provided under rights of private practice at public hospital outpatient departments.
Guideline for substantiating that a patient attended a service
  • This guideline outlines what you can do to substantiate that a patient attended a service and relates to MBS items such as 23, 36, 104, 5020, 10960 and 8553 that require the patient to be present.
Accessing Medicare Easyclaim reports using HPOS
  • A guide to using HPOS to generate bulk bill processing and payment reports for Medicare Easyclaim.
eLearning program – Viewing a patient’s care plan history
  • This module contains information on how to view your patient’s care plan history for the last 12 months in Health Professional Online Services (HPOS). Your patient’s care plan is recorded against their Medicare record.
eLearning program – Using the MBS items online checker in HPOS
  • This module will teach you how to use the MBS items online checker in HPOS to confirm patient and claim eligibility.
Infographic – Viewing a patient’s care plan history in HPOS
  • A flowchart outlining how to view a patient’s care plan history in HPOS.
Infographic – MBS items online checker
  • The MBS items online checker available in HPOS enables you to search and check patient eligibility based on their MBS history, check your own eligibility for claiming MBS items and check MBS item claiming conditions.
How to access Medicare bulk bill reports in HPOS
  • This resource shows you how to access bulk bill payment and processing reports in HPOS. You will be able to view claims that have been successfully submitted and paid, and any claims processed with errors.
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.
Medicare billing in public hospitals – Overview
  • Public patients in a public hospital receive services free of charge. However, patients may elect to be a private patient and claim Medicare benefits instead.
  • To ensure appropriate billing, you need to know when patients can claim Medicare benefits when they attend a public hospital.
Frequently asked questions about Medicare billing in public hospitals
  • These FAQs answer commonly asked questions on public hospital funding for public patients, and appropriate Medicare billing for private patients in public hospitals.
eLearning module – Billing Medicare in public hospitals
  • This program provides information on correctly billing Medicare for services provided to patients in public hospitals, focusing on the billing and claiming requirements for:
    • consultation services in public hospitals
    • exercising rights of private practice
    • services provided under rights of private practice at outpatient departments.
Case studies
The case studies below will help you improve your Medicare billing practices.
Case study – Billing of diagnostic and pathology services in emergency departments and for public patients
Case study – Billing only for services provided
Case study – Election status and responsibility for care and funding in a complex patient journey
Case study – MBS billing for registrar services and requirements to personally perform services
Case study – Patient election to receive a public or private service
Case study – Public patient discharge process, aftercare and transition of care
Case study – Rights to private practice and billing by hospital-salaried providers
Case study – Rural
Case study – Service locations and private services in public hospitals
 
MBS Note AN.0.52 – Medication management reviews
  • Outlines claiming requirements for MBS items 900 and 903.
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.0.57 – Provision of Focussed Psychological Strategies
  • Outlines claiming requirements for MBS items 2721, 2723, 2725, 2727, 91818, 91819, 91842 and 91843.
MBS Note AN.20.1 – Provision of Focussed Psychological Strategies to a person other than the patient
  • 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 – GP Mental Health Treatment Medicare items
  • Frequently asked questions about GP Mental Health Treatment Medicare items.
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.
MBS Note MN.12.3 – Item 10987
  • Outlines claiming requirements for MBS item 10987.
MBS Note MN.12.4 – Item 10997
  • Outlines claiming requirements for MBS item 10997.
MBS Note MN.12.5 – Telehealth support services by health professionals
  • Outlines claiming requirements for MBS item 10983.
Education guide – Practice nurse items
  • Information about how to claim services provided by a practice nurse on behalf of a medical practitioner.
eLearning program – Medicare items for eligible practice nurses
  • This module provides information on how to claim services provided by a practice nurse on behalf of a medical practitioner.
Infographic – Practice nurse MBS items
  • A list of practice nurse MBS items. These services are provided on behalf of a supervising medical practitioner. The items are billed using the medical practitioner’s provider number.
Fact sheet – Correct billing of MBS item 10997
  • This fact sheet lists examples of how MBS item 10997 can be claimed by medical practitioners. It is intended for patients with chronic or terminal medical conditions who need access to ongoing care.
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.
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.15.39 – Practitioners should maintain adequate and contemporaneous records
  • This note explains what is meant by ‘adequate’ and ‘contemporaneous’ records.
Administrative record keeping guidelines for health professionals
  • These guidelines provide useful information and tools to support good administrative record keeping within your practice.
Record keeping tips
  • These 10 simple tips will help you establish and maintain an effective administrative record keeping system.
Guide to Medicare for Indigenous health services
  • This comprehensive guide provides information about Medicare Indigenous health services.
eLearning programs
Medicare Indigenous enrolments
  • This module provides an overview of the benefits of Medicare enrolment and identification for Aboriginal and Torres Strait Islander patients for participation in the Medicare program and their access to better health services.
Case study – Managing diabetes
  • This case study illustrates how health professionals can provide primary and preventive healthcare to support managing chronic conditions for Aboriginal and Torres Strait Islander patients under Medicare.
Case study – Accessing mental health services
  • This case study illustrates how health professionals can provide access to mental health services for Aboriginal and Torres Strait Islander patients under Medicare.
Case study – Managing asthma
  • This case study illustrates how practices can provide primary and preventive care to support better health outcomes for Aboriginal and Torres Strait Islander patients managing asthma conditions.
Indigenous health assessments
  • This module provides an overview of MBS services available for practices providing primary and preventive care to support better health outcomes for Aboriginal and Torres Strait Islander patients.
Case study – Accessing telehealth services
  • This case study illustrates how health professionals can provide telehealth services for Aboriginal and Torres Strait Islander patients under Medicare.
Quality Assurance in Aboriginal Medical Services (QAAMS) Program
  • This module provides an overview of the QAAMS Program.
Aboriginal Health Workers
  • This module explains the key MBS requirements for claiming services provided by an Aboriginal Health Worker, including services provided on behalf of medical practitioners.
Aboriginal and Torres Strait Islander Health Practitioners
  • This module explains the key MBS requirements for claiming services provided by an Aboriginal and Torres Strait Islander Health Practitioner, including services provided on behalf of medical practitioners.
Closing the Gap (CTG) Pharmaceutical Benefits Scheme (PBS) Co-payment Program
  • This module provides an overview of the CTG PBS Co-payment Program.
Infographics
Check your patient’s details every time
  • Help your patient get the Medicare services they need by performing these eight simple checks.
Quality Assurance in Aboriginal Medical Services (QAAMS)
  • QAAMS point-of-care testing provides access to on-site testing at the time of a patient consultation for three specific diabetes related tests.
Completing an Aboriginal and Torres Strait Islander health assessment
  • A flowchart outlining the steps involved in completing an Aboriginal and Torres Strait Islander health assessment.
GP-led primary care planning for Indigenous patients
  • A flowchart outlining primary care pathways for Indigenous patients.
Aboriginal and Torres Strait Islander health assessment continuity of care
  • Information about referring a patient for health assessment follow-up services when circumstances change.
Aboriginal Health Worker MBS items
  • A list of Aboriginal Health Worker MBS items.
Aboriginal and Torres Strait Islander Health Practitioner MBS items
  • A list of Aboriginal and Torres Strait Islander Health Practitioner MBS items.
Indigenous Health Incentive registration
  • Information on how to register patients for the Practice Incentives Program (PIP) Indigenous Health Incentive.
Applying for the Indigenous Health Incentive
  • Information on how to apply for the PIP Indigenous Health Incentive through HPOS.
Register a patient for the Indigenous Health Incentive online
  • Information on how to register a patient for the PIP Indigenous Health Incentive online through HPOS.
Search for a registered patient in the Indigenous Health Incentive
  • Information on how to search for a previously registered patient in the PIP Indigenous Health Incentive through HPOS.
Withdraw a practice from the Indigenous Health Incentive
  • Information on how to withdraw a practice from the PIP Indigenous Health Incentive through HPOS.
Withdraw a patient from the Indigenous Health Incentive
  • Information on how to withdraw a patient from the PIP Indigenous Health Incentive through HPOS.
Simulations
These short videos will take you through the steps required to complete the following tasks.
How to register a patient for the Closing the Gap PBS Co-payment
Applying for the Indigenous Health Incentive
Register a patient for the Indigenous Health Incentive
Search for a registered patient in the Indigenous Health Incentive
Withdraw a practice from the Indigenous Health Incentive
Withdraw a patient from the Indigenous Health Incentive
 
MBS Note AN.0.73 – Attendance services for eligible disabilities
  • Outlines claiming requirements for MBS items 139 and telehealth equivalent 92142.
MBS Note AR.29.1 – Attendance services for eligible disabilities
  • This note provides a list of eligible disabilities for the purposes of claiming MBS items 139 and 92142.
eLearning program – MBS services available for patients with a disability
  • This module provides information about MBS items supporting early diagnosis, assessment and treatment for patients with a disability or complex neurodevelopmental disorder.
Eligible disability MBS flowchart of services
  • A flowchart outlining MBS services available to patients with an eligible disability.
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.
Fact sheets – MBS telehealth services
  • These fact sheets provide information about ongoing MBS telehealth arrangements.
Medicare compliance and telehealth services
  • This fact sheet provides information about the prescribed pattern of service (30/20) rule for phone services introduced on 1 October 2022.
AskMBS Advisory – Established clinical relationship – Clarification of exemptions
  • Information and advice for GPs and other medical practitioners about the COVID-19 MBS telehealth established relationship requirement, including clarification of exemptions.
MBS Note AN.1.1 – Patient’s usual medical practitioner
  • It is a legislative requirement that GPs and other medical practitioners working in general practice must only perform a telehealth or telephone service where they have an established clinical relationship with the patient.
RACGP frequently asked questions
  • FAQs developed by the RACGP about the established clinical relationship rule for telehealth services.
  • Outlines claiming requirements for MBS items 93644, 93645, 93653, 93654, 93660, 93661, 90005 and 10660.
Education guide – Medicare billing for immunisations
  • Information about billing MBS attendance items for immunisations.
Medicare support for COVID-19 vaccinations
  • Information on MBS COVID-19 vaccine suitability assessment services from 1 February 2023.
FAQ – Bulk billed MBS patient COVID-19 vaccine suitability assessment service
  • This page includes links to frequently asked questions about MBS COVID-19 vaccine items and scenarios to assist with correct billing.

Advertising

Advertising