Decision Making Powers:
(Refer to PSR Guide)
As a peer review process the Professional Services Review Scheme has been designed to ensure that appropriately qualified individuals will make decisions on whether an inappropriate claim has been made against the MBS or PBS.
The process has also been designed to give a number of opportunities to a practitioner to present their case and to respond to the findings of their peers.
There are 3 Main decision making stages in the PSR process:
- The Director of PSR determines to conduct a review, (s88A) has the power to require production of a practitioner's clinical notes (s89B) and can decide to enter an agreement with the practitioner (s92) or refer the matter to a PSR committee (s93).
- The peer review Committee undertakes a review to determine if inappropriate practice has occured. They can require the production of a practitioner's clinical notes (s105A) and must issue their decision in the form of a written report (s106L).
- The Determining Authority determines what the appropriate outcomes in specific PSR matters are. They have the power to order repayments, reprimand or counsel a practitioner or suspend them from the Medicare or PBS for up to 3 years (s106U).
It is important to note that the Professional Services Review process can have significant outcomes. The professionals who sit on Committees and the Determining Authority take their responsibilities very seriously, and do not make decisions to find inappropriate practice or sanction their peers lightly.
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