The MBS and PBS items most likely to get you pinged

3 minute read

The PSR has published the numbers that are most often subject to compliance review, prompting the RACGP president to say GPs’ fear is overblown.

Items relating to standard GP consults and chronic disease management make up the majority of the top MBS and PBS items subject to Medicare compliance review, according to an overview provided by the PSR.

The overview was presented during the PSR’s biannual General Practice Advisory Committee meeting, chaired by the RACGP’s President Dr Nicole Higgins, earlier this month. According to Dr Higgins the meeting provided the opportunity to raise concerns over the PSR’s processes.

The top 10 items subject to review over the two recent financial years were:

  1. 23
  2. 723
  3. 36
  4. 721
  5. 732
  6. 91809
  7. 5020
  8. 2713
  9. 1215Y (PBS)
  10. 5040

Only one item, 1215Y (paracetamol + codeine) was related to PBS compliance.

One of the major concerns cited in the overview was inadequate record keeping. The PSR noted that records needed to include sufficient notes to understand what consultation time was spent on and the reasons for any prescribing – especially in the case of antibiotics.

The overview also noted a lack of tailoring of chronic disease management templates and no changes in plans over several years, as major concerns relating to the chronic disease management items.

Many concerns resulting in the review of item 723 (team care arrangements) were due to a lack of consultation with other providers that would be involved in providing these multidisciplinary plans.

The PSR said that no location or type of practice seemed to correlate with increased Medicare compliance review.

Speaking to The Medical Republic, Dr Higgins was unsurprised by the top compliance concerns “because these are the most commonly used item numbers”.

Despite the relatively small number of GPs subject to PSR review – 131 over the past two financial years – many doctors and colleges have raised concerns over the toll the process can take on GPs and the potential for coercion into repayment deals.

Dr Higgins emphasised the minimal incidence of review of each of the item numbers.

“What GPs need to take from this [is that] it is such a tiny number of our profession that end up in front of the PSR,” she said.

“Our fear is out of perspective with what’s really happening.”

As a GP, Dr Higgins said she “understands the fear of the PSR” but that in working with the agency she has grown to understand the system better.

“[The PSR] are for the doctor, they’re very aware of the doctor’s health, and it’s peer reviewed,” she said.

“We’ve now developed a close working relationship with the PSR and Medicare compliance to actually be able to prevent people coming to the attention in the first place.”

Dr Higgins said PSR Acting Director Dr Antonio Di Dio has been “instrumental in leading this from a doctor’s health perspective and an educational perspective”.

The groups have been working to develop educational resources on Medicare compliance for doctors, which will be incorporated into training.

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