PSR Annual Report 2007-08
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Glossary
- 80/20 rule
- see prescribed pattern of services
- Act
- Health Insurance Act 1973, as amended by the Health Legislation (Professional Services Review) Amendment Act 1994 and subsequent amendments
- 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 Medicare Australia
- Cox-2
- A selective inhibitor – the newest of the non-steroidal anti-inflammatory drugs
- Determining Authority
- A three-person panel responsible for determining the sanction following an adverse PSR Committee finding
- 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
- ECG
- electrocardiogram
- EPC
- enhanced primary care
- inappropriate practice
- Conduct in connection with rendering or initiating services for which a Medicare benefit was payable, and which a committee of peers could reasonably consider would be unacceptable to the general body of the peer group (section 82 of the Act)
- Level A service
- A professional attendance for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management.
- Level B service
- A professional attendance involving taking a selective history, examination of the patient with implementation of a management plan.
- Level C service
- A professional attendance involving taking a detailed history, an examination of multiple systems, arranging necessary investigations and implementing a management plan in relation to one or more problems and lasting at least 20 minutes.
- Level D service
- A professional attendance involving taking an exhaustive history, a comprehensive examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to one or more complex problems, and lasting at least 40 minutes.
- MBS
- Medicare Benefits Schedule
- Minister
- Minister for Health and Ageing
- Panel
- PSR Panel consisting of medical practitioners, dentists, optometrists, chiropractors, physiotherapists, osteopaths and podiatrists appointed by the minister following consultation with the relevant professional organisations
- PBS
- Pharmaceutical Benefits Scheme
- Prescribed pattern of services
- A prescribed pattern of services is also known as the 80/20 rule, whereby a practitioner is deemed to have practised inappropriately if he or she renders 80 or more services on 20 or more days in a 12-month period
- 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 Medicare Australia asking the Director to review the provision of services and containing Medicare Australia’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.
- Schedule 4 drugs
- Restricted drugs
- Schedule 8 drugs
- Drugs of addiction
- VRGP
- Vocationally Recognised General Practitioner
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