| Act |
Health Insurance Act 1973, as amended by the Health Legislation (Professional Services Review) Amendment Act 1994 and subsequent amendments |
| adjudicative referral |
A case prepared by the Director, instituting a referral to a PSR committee, after an investigation of the concerns contained in an investigative referral. (From 1 January 2003 the Director makes a referral to a PSR committee to investigate concerns.) |
| AMA |
Australian Medical Association |
| committee |
A Professional Services Review committee established by the Director in accordance with section 93 of the Act to examine a case of apparent ‘inappropriate practice’ referred by the Health Insurance Commission |
| deeming |
A prescribed pattern of services under section 106KA of the Act that is deemed to be inappropriate practice |
| Determining Authority |
A three-person panel responsible for determining the sanction following an adverse PSR committee finding |
| Determining Officer |
An officer appointed by the Minister to determine an appropriate sanction to apply where a PSR committee finds a person under review has engaged in inappropriate practice, as defined in the Act |
| Director |
The Director of Professional Services Review is an independent statutory officer appointed by the Minister—the occupant must be a medical practitioner and the AMA must agree to the appointment |
| disqualification |
Exclusion (partial or complete) from eligibility for the practitioner’s services to attract Medicare benefits |
| inappropriate practice |
Professional conduct in relation to Medicare which a committee of peers would reasonably consider would be unacceptable to the general body of the peer group (section 82) |
| investigative referral |
A case prepared by the Health Insurance Commission and referred to the Director, containing the Commission’s concerns and the reasons it considers a practitioner or other person may have engaged in inappropriate practice in the terms of section 82 of the Act. (From 1 January 2003, the Commission asks the Director to review the provision of services by a practitioner.) |
| MBS |
Medicare Benefits Schedule |
| MPRC |
Medicare Participation Review Committee |
| Minister |
Minister for Health and Ageing |
| panel |
PSR panel consisting of medical practitioners, dentists, optometrists, chiropractors, physiotherapists and podiatrists nominated by the relevant professional organisations and who have been appointed by the Minister |
| PBS |
Pharmaceutical Benefits Scheme |
| PSR |
Professional Services Review |
| referral |
A case prepared by the Director and referred to a PSR committee for investigation, detailing the concerns and the reasons a practitioner or other person may have engaged in ‘inappropriate practice’ in the terms of section 82 of the Act |
| request for review |
A case prepared by the Commission asking the Director to review the provision of services and containing the Commission’s concerns and the reasons it considers a practitioner or other person may have engaged in inappropriate practice in the terms of section 82 of the Act. (Applies from 1 January 2003) |
| 80/20 rule |
A prescribed pattern of services applying to practitioners providing 80 or more professional attendances on 20 or more days in a 12-month period |