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Professional Services Review

The following articles have the tag Professional Services Review

Incompetency claim thrown out by tribunal

THE Medical Board of Australia (MBA) says it will “consider the implications”, after a GP who congratulated a patient for refusing to vaccinate her child avoided disciplining by a tribunal - despite the MBA’s push for a finding of incompetency.

$1.1m drop in wrongly claimed Medicare funds since PSR panel sacking

THE forced resignation of all Professional Services Review (PSR) panellists in late 2010 has contributed to a $1.1 million drop in incorrectly claimed Medicare funds recovered by the peer watchdog.

Govt labelled ‘hypocritical’ over new 80-20 breach laws for PSR

GPs who breach Medicare’s 80-20 rule will be automatically deemed to have practised inappropriately under new laws expected to be passed by parliament, and which will retrospectively validate a decade’s worth of committee findings.

Doctors line up to challenge PSR findings

LAWYERS involved in a Federal Court win over the Professional Services Review (PSR) have been swamped with calls from GPs forced to pay back money to Medicare as the blame game continues over the bureaucratic failure that could invalidate a decade of committee findings.

PSR to release report despite criticism

PROFESSIONAL Services Review director Dr Tony Webber says he will issue a report to the professions this year despite criticism from the AMA that the reports have been used in the past by the media to unfairly ‘bash’ doctors. Writing in the latest issue of Australian Medicine , AMA vice president Dr Steve Hambleton said Dr Webber had put “a headline ahead of the facts” by citing “isolated examples of inappropriate practice and claiming that they were widespread”. Dr Webber’s comments had caused the profession to lose faith in the Professional Services Review (PSR) while ...

Patient privacy concerns over ‘disturbing’ new laws

MEDICARE has been granted Commonwealth powers to force GPs to hand over patient records, prompting concerns that non-medical bureaucrats will be able to lawfully inspect confidential personal information. Legislation passed by Federal Parliament last week, backed by both major parties, will increase Medicare compliance audits fivefold and will force doctors to produce requested documentation – including patient notes – when suspected of inappropriate claims. Previously, doctors have not been legally obliged to provide documents, and one in five has refused when audited, the Federal Government claims. Under the new laws, however, doctors face hefty fines for refusing ...

Most GPs fear they’d fail an EPC item audit

MORE than 80% of GPs are not certain they would pass a Medicare compliance audit on the use of enhanced primary care (EPC) items, a new survey of frontline GPs has revealed. The survey of more than 200 GPs shows that 55% do not have confidence they would pass such an audit, while 31% are unsure. Furthermore, 90% of GPs do not have confidence that Medicare auditing and compliance processes provide natural justice.  Queensland GP Dr Scott Masters, who spearheaded the poll, said the results suggested GPs were changing the way they practised. “It shows the ...

Most GPs fear they’d fail an EPC item audit

MORE than 80% of GPs are not certain they would pass a Medicare compliance audit on the use of enhanced primary care (EPC) items, a new survey of frontline GPs has revealed. The survey of more than 200 GPs shows that 55% do not have confidence they would pass such an audit, while 31% are unsure. Furthermore, 90% of GPs do not have confidence that Medicare auditing and compliance processes provide natural justice. Queensland GP Dr Scott Masters, who spearheaded the poll, said the results suggested GPs were changing the way they practised. “It shows ...

Medicare survey finds audits have their upside

GPs fed up with ongoing ambiguities in the MBS can take heart from a recent Medicare survey showing strong health professional satisfaction with its audit processes. A recent Medicare survey of almost 200 health professionals who had undergone compliance audits has found that 93% agreed or strongly agreed they were treated in a professional manner.  More than three-quarters found the information provided during the process to be helpful to them in correctly interpreting the MBS. Queensland GP Dr Scott Masters isn’t one of them. His recent attempts to secure a definitive description of a Level C consultation saw ...

Proposed law will boost Medicare watchdog’s power over doctors

THE Professional Services Review (PSR) may soon be able to request that doctors hand over pathology specimens relevant to its investigations, under proposed legislation revealed last week.  Under proposed amendments to the Health Insurance Amendment (PSR) Bill, the Medicare watchdog will be given powers to subpoena any “relevant objects” pertaining to suspect inappropriate claims. These can include pathology specimens, pharmaceutical preparations or medical equipment. PSR director Dr Tony Webber said such requests could be made in cases where the watchdog had reason to believe doctors had falsely claimed higher rebates for malignant legion removal and excision procedures. ...

‘Defensive medicine’ no excuse, despite GP being sued

‘Defensive medicine’ no excuse, despite GP being sued

A PATIENT payout of $290,000 has triggered further debate into the ordering of CT scans, with a leading doctors’ group arguing their increasing use may be partly attributed to GPs practising defensive medicine. Last week the NSW Supreme Court awarded compensation to 59-year-old Sandra Thompson after her GP failed to refer her for a CT scan. After a year of neck pain that radiated down her right arm, Ms Thompson was diagnosed with spinal cord impingement and cervical myelopathy. The judgement comes just weeks after Professional Services Review director Dr Tony Webber highlighted a worrying upward trend ...

Confusion rules in murky world of long consult claiming

Government efforts to clarify Level C and D item descriptors appear to have failed according to an MO poll, with less than a third of GPs saying they felt adequately informed of MBS changes due to take effect on 1 May. Half of the 150 GPs surveyed by Cegedim Strategic Data on behalf of Medical Observer said they did not feel they had been given enough information or time to consider how the new descriptors for C and D items will impact on their practice. The results reflect ongoing confusion among GPs over claiming ...

GPs put under pressure to create team care plans: MO Poll

GPs put under pressure to create team care plans: MO Poll

ALLIED health professionals and patients are pressuring GPs to draw up team care plans despite only half of GPs believing they offer any value to patients, a new Medical Observe r poll has revealed.  With GPs acting as the main gatekeepers of MBS-funded enhanced primary care items, patients and allied health professionals alike are requesting team care plans from doctors to facilitate access – a practice some have dubbed “reverse referrals”. The national poll found that 75% of GPs surveyed had come under pressure from patients to provide the plans, while 74% said they had faced ...

GPs warned to obey the rules on team care plans

GPs have been warned not to be pressured into writing team care plans for ineligible patients, with the Professional Services Review (PSR) citing a rise in unjustifiable claims. While also indicating a rise in inappropriate prescribing of narcotics and benzodiazepines, the annual report of the profession’s watchdog highlighted a trend of GPs writing care plans for patients for conditions that fall outside the team care item descriptor. Item 723 stipulates that patients must have an existing chronic or terminal medical condition requiring ongoing care from a multidisciplinary team of their GP and at least two other health ...

Allied health faces Medicare scrutiny

AS Medicare Australia begins scrutinising nearly 200 allied health professionals as part of its ramped-up auditing activities, the Federal Government has flagged new plans to have them answer to the Professional Services Review (PSR) as well. Podiatrists, physiotherapists, chiropractors and dietitians are among those earmarked for audits, which will examine MBS services provided between February and August last year. Only a limited number of allied health professionals can currently be referred to the PSR; however, legislative changes will see the body able to peer-review all allied health professionals with access enhanced primary care item rebates. A ...

Transparency on specialist Medicare audits still lacking

GPs have renewed calls for specialists to be brought under the same level of scrutiny as general practice through fairer targeting of Medicare audits across the health professions. AMA council of general practice chair Dr Rod Pearce said despite Medicare’s efforts to introduce such parity, GPs were still disproportionately audited and subsequently referred to the Professional Services Review (PSR). A 2007 review of the PSR found that fewer than 5% of all practitioners referred to the body between 1999 and 2007 were specialists ( MO , 5 October 2007 ), despite the fact that they accounted ...

Clearer targets

Specialists and allied health workers may be about to feel the heat under plans to broaden the net of the Professional Services Review. Pamela Wilson reports. LIKE the outer rings of a bullseye, GPs have long been an easy mark for the Professional Services Review (PSR). But the red centre that is specialists – and, soon, allied health practitioners – is about to get a lot bigger. The vast majority of practitioners called into question by Medicare Australia and the PSR are GPs, simply because as a group their billing practices are easier to ...

Can anyone read your notes?

Clinical notes can help you in court and with the Professional Services Review, but records aren’t always up to scratch, as Mandy Bryan discovers in the second of this two-part series. IT’S common knowledge: having good medical records is good clinical practice and can make or break your defence. But at least 80% of those GPs fined thousands of dollars for inappropriate practice in the year to June 2008 were caught short here, according to the Professional Services Review (PSR). Though there were other factors at play in these cases, records were still a ...

The PSR penalty

The latest PSR report identifies four main areas where GPs slip up. Mandy Bryan reports on the common mistakes in the first of this two-part series. WHEN Cairns-based general practitioner Dr M prescribed high levels of narcotics but failed to document the rationale and proposed management of patients on this long-term therapy, he paid a hefty price. Medicare benefit repayments worth $188,256 and full disqualification for six months were among the penalties, and he was also referred to the Medical Board of Queensland for further investigation. GP Dr J of Sydney was also found ...