Department announces new ‘early intervention’ compliance campaign

A small minority of GPs will soon be contacted by the Department of Health and Aged Care (DoH) as part of its latest round of 80/20 rule reviews.
 
The Federal Government has confirmed 146 letters will be sent to those at risk of inappropriate practice or of referral to the Professional Services Review (PSR) Director by exceeding the prescribed pattern of service rule, which aims to limit low-value care and inappropriate billing.
 
GPs who are approaching the threshold for the 12-month data period will soon be sent the early intervention letter, which includes information on how to review their servicing behaviours.
 
The letter, seen by newsGP, informs recipients that departmental records indicate that they ‘may be at risk’ of breaching the 80/20 rule.
 
‘Breaching the 80/20 rule is considered to constitute inappropriate practice, except in exceptional circumstances,’ it reads.
 
‘The 80/20 rule aims to address consistently high volumes of rendered or initiated services by medical practitioners.
 
‘This is an opportunity for you to review your servicing levels before concerns are escalated. While there are no legislative constraints for providing more than 80 services in a day, it is important to ensure that each service is clinically relevant, medically necessary and provided in an appropriate manner.’
 
Recipients of the letter are told to review their servicing and monitor the number of services rendered daily.
 
RACGP President Dr Nicole Higgins told newsGP early intervention represents a welcome departure from previous punitive approaches and that GPs should be told when they are nearing their threshold.
 
‘This is a much-improved approach,’ she told newsGP.
 
‘The important thing is, because of the work that we’ve been doing with the PSR, there’s only a very small number of members that will be affected.
 
‘This is an opportunity to reflect on practice. It’s an educational approach versus a punitive approach.’
 
The RACGP met with PSR Director Dr Antonio Di Dio last week to discuss the measures, and continue its collaborative relationship with the college.
 
Dr Higgins said this round of letters is a vast improvement on the hundreds of compliance warnings sent out in February, questioning GPs’ use of MBS item number 10997.
 
GPs were left angry and confused by the crackdown, after around 600 doctors were warned for co-claiming practice nurse item 10997 and a chronic disease management (CDM) item for the same patient on the same day.
 
RACGP campaigning against the letters led to Federal Health and Aged Care Minister Mark Butler asking the DoH to consider how further guidance could be provided to assist health practitioners correctly bill the items.
 
‘There’s still a lot of anger around the 10997 item numbers investigation earlier this year,’ Dr Higgins said.
 
‘Our conversations with the department and with the PSR have been about making sure that we don’t indiscriminately target members unless there’s reasonable evidence.’
 
Further information on the 80/20 rule is available on the DoH website, or questions can be submitted via email to voluntary.compliance.team@health.gov.au.
 
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10997 80/20 rule compliance MBS Medicare