Glossary
- the Act
- means the Health Insurance Act 1973.
- AMA
- means the Australian Medical Association.
- Case officer
- means the PSR staff member who coordinates the administration of Professional Services Review matters.
- Committee
- means a PSR Committee comprising at least three practitioners appointed under section 93 of the Act. Sometimes referred to as PSRC.
- Committee member
- means a member of a Committee, who must be a current Panel member.
- Deputy Director
- means a Deputy Director of PSR appointed under section 85 of the Act; who serves as the chair of the Committee.
- Determining Authority
- means the independent statutory body established under the section 106Q of the Act.
- Director
- means the Director of PSR appointed under section 83 of the Act. Sometimes referred to as the DPSR.
- Director's Review
- means the process undertaken by the Director under Division 3A of Part VAA of the Act.
- DHS
- means the Department of Human Services
- Draft Determination
- means the draft document containing what action is proposed to be taken in a case as required by section 106T of the Act.
- Draft Report
- means the preliminary findings of a Committee following a hearing as required by section 106KD of the Act.
- Final Determination
- means the final document containing what action will be taken in a case as required by section 106TA of the Act.
- Final Report
- means the final findings of a Committee following assessment of further submissions by a practitioner following the Draft Report as required by section 106L of the Act.
- Health
- means the Department of Health who have portfolio responsibility for the Professional Services Review Scheme. Delegates of the Chief Executive Medicare, located in the Department of Health, refer matters to PSR for investigation.
- Inappropriate practice
- is defined under section 82 of the Act as conduct in connection with rendering or initiating services that a Committee of the practitioner's peers could reasonably conclude was unacceptable to the general body of their profession.
- MBS
- means the Medicare Benefits Schedule.
- Medicare
- means the Medicare program.
- Medicare Services
- means services provided by a practitioner which generated a Medicare Benefit.
- Minister
- means the Minister for Health.
- Negotiated Agreement
- means a written Agreement made under section 92 of the Act.
- Over-servicing
- means providing a patient with services in excess of the patient's actual medical need.
- Panel
- means the PSR Panel established under subsection 84(1) of the Act, members of which are available for appointment to a Committee.
- Panel member
- means a practitioner appointed under subsection 84(2) of the Act.
- PBS
- means Pharmaceutical Benefits Scheme.
- Peers
- means the members of the Professional Services Review Panel who are appointed to represent the general body of their profession.
- Person Under Review (PUR)
- means a practitioner or another person or corporate entity who has been referred to the Director for review.
- Practitioner
- means a medical practitioner, dental practitioner, optometrist, midwife, nurse practitioner, chiropractor, physiotherapist, podiatrist, osteopath, as well as an audiologist, diabetes educator, dietician, exercise physiologist, mental health nurse, occupational therapist, psychologist, social worker, speech pathologist, Aboriginal and Torres Strait islander health practitioner, Aboriginal health worker and orthoptist.
- Prescribed pattern of services (the 80/20 rule)
- means practitioners who provide 80 or more relevant professional attendance services on each of 20 or more days during a review period are taken to have engaged in inappropriate practice and are automatically referred to PSR. If exceptional circumstances are established, the volume of inappropriate practice is reduced by those days on which exceptional circumstances are found to have existed and affected a person under review’s provision of services
- PSR
- means Professional Services Review.
- Ratify
- means to authorise or approve - used when the Determining Authority is deciding if an Agreement with the Director will come into effect.
- Review period
- means a period of no more than two years prior to the date of the request for review from the Delegate of the Chief Executive Medicare as specified in the request to PSR.
- Sanction
- means a penalty from a range of directions specified in section 106U of the Act.
