Glossary and indexes
Glossary
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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 Health Insurance Act 1973 to examine a case of apparent ‘inappropriate practice’ referred by Medicare Australia. |
|
Determining Authority |
A three-person panel responsible for determining the sanction following an adverse PSR Committee finding. |
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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 Australian Medical Association must agree to the appointment. |
|
disqualification |
Exclusion (partial or complete) from eligibility for the practitioner’s services to attract Medicare benefits. |
|
ECG |
electrocardiogram |
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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 Health Insurance Act 1973). |
|
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. |
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Level B service |
A professional attendance involving taking a selective history, examining the patient and implementing a management plan. |
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Level C service |
A professional attendance involving taking a detailed history, examining multiple systems, arranging any necessary investigations and implementing a management plan for one or more problems, and lasting at least 20 minutes. |
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Level D service |
A professional attendance involving taking an exhaustive history, conducting a comprehensive examination of multiple systems, arranging any necessary investigations and implementing a management plan for one or more complex problems, and lasting at least 40 minutes. |
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MBS |
Medicare Benefits Schedule |
|
Minister |
Minister for Health and Ageing |
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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. |
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PBS |
Pharmaceutical Benefits Scheme |
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Prescribed pattern of services |
A prescribed pattern of services is also known as the 80/20 rule, whereby a practitioner is deemed to have practiced inappropriately if he or she renders 80 or more services on 20 or more days in a 12-month period. |
|
PSR |
Professional Services Review |
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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 Health Insurance Act 1973. |
|
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 Health Insurance Act 1973. |