Practice Incentives Program

General Practitioner Aged Care Access

Incentive GuidelinesSeptember 2013
Introduction
The Practice Incentives Program (PIP) is aimed at supporting general practice activities that encourage continuing
improvements and quality care, enhance capacity and improve access and health outcomes for patients.
For more information on the incentives that the PIP offers and overall PIP eligibility, go to the PIP guidelines at
humanservices.gov.auhealthpro!essionals then Incentives and Allo"ances > Practice Incentives Program >
#orms and guidelines.
$he PIP GP Aged Care Access Incentive
The PIP GP ged !are ccess Incentive (!I) aims to encourage GPs to provide increased and continuing services
in "esidential ged !are Facilities ("!Fs).
%ligibilit&
To be eligible for the PIP GP !I payments, GPs must#
$or% from a PIP practice
provide eligible &edicare 'enefits (chedule (&'() services to residents in "!Fs
reach the )ualifying (ervice *evel ()(*) by providing the required number of &'( services in "!Fs in a
financial year, and
use a &edicare provider number that+s lin%ed to a PIP practice $hen claiming &'( services in "!Fs.
Pa&ments and re'uirements
The PIP GP !I payments are based on a GP providing a required number of eligible &'( services in "!Fs in a
financial year. The PIP GP !I has t$o payment tiers $hich are summarised in Table , belo$.
$able 1( PIP GP !I payments and requirements
$ier
)uali!&ing Service *evel
+)S*,
Service Incentive Pa&ment
+SIP,
Tier , -. services /,0..
Tier 1 ,2. services /30..
To receive the#
Tier , payment of /,0.., GPs must provide at least -. eligible &'( services in "!Fs in a financial year
Tier 1 payment of /30.., GPs must provide at least ,2. eligible &'( services in "!Fs in a financial year.
4ligible GPs can receive t$o payments totalling /0... for the financial year. The payments are in addition to the
consultation fee.
Payments are automatically paid to GPs $ho reach the )(*s by providing the required number of eligible &'(
services in "!Fs (see Table ,).
For services to be counted to$ards the )(*s, GPs must claim the &'( services provided in "!Fs using a &edicare
provider number that+s lin%ed to a PIP practice.
%ligible -.S items
4ligible &'( services are those provided to residents in !ommon$ealth5funded "!Fs and &ultipurpose (ervices.
-ultipurpose Services are integrated health and aged care services that provide !le/ible and sustainable service
options !or small rural and remote communities.
-.S services that count to"ards the )S*s include attendances in 0AC#s1 contributions to Care Plans and
0esidential -edication -anagement 0evie"s.
$he -.S items that count to"ards the )S*s are( 201 321 331 211 421 431 421 451 6311 4031 20101 20271 20341 20561
22501 22531 2252 and 2256.
$his list ma& be revised b& us to include or remove -.S items.
#or more in!ormation on the use and billing o! -.S items call 132 1208.
Appl&ing
GPs from PIP practices don+t need to apply for this incentive. If your practice isn+t currently in the PIP you can apply#
through 6ealth Professional 7nline (ervice (6P7(), at humanservices.gov.au9P:S, or
by completing the PIP application form, at humanservices.gov.auhealthpro!essionals then Incentives and
Allo"ances > Practice Incentives Programs > #orms and guidelines and sending it along $ith the
required supporting documentation, to#
&ail# Incentive Programs
;epartment o! 9uman Services
GP: .o/ 2262
A;%*AI;% SA 2001
Fa8# 1300 276 545
9o" pa&ments are made
7nce the required number of &'( items has been claimed, the (IPs are automatically paid in the ne8t PIP payment
quarter into the ban% account nominated by the GP. If $e don+t have the GP+s ban% details, a form $ill be
automatically sent to the GP+s main PIP practice branch after $e process the &'( claims for services provided in
"!Fs.
:bligations o! the practice andor GP
The practice must#
give information to 6uman (ervices as part of the ongoing audit process to verify that the practice has met
eligibility requirements
ma<e sure the in!ormation given to 9uman Services is correct1 and
advise 9uman Services o! an& changes to practice arrangements. $his can be done(
online via 9P:S. Changes via 9P:S are immediate and can be made up to1 and on1 the relevant
pointintime date
b& completing the PIP Change of Practice Details !orm1 or b& advising 9uman Services in
"riting b& no later than seven da&s prior to the relevant point=in=time date.
0e!er to the PIP guidelines !or more in!ormation.
$he pointintime date corresponds to the last da& o! the month be!ore the ne/t PIP 'uarterl& pa&ment.
:n >oining the PIP1 the practice must nominate an authorised contact person+s,1 "ho "ill con!irm1 on the
practice?s behal!1 an& changes to in!ormation !or PIP claims and pa&ments.
Appeals process
The PIP has an established appeals process. To as% for a revie$ of a decision, the authorised contact person or the
o$ners of the practice must $rite to us $ithin 19 calendar days of the date of the letter informing the practice of the
decision. 6uman (ervices $ill revie$ the decision and advise the practice in $riting of the outcome.
#or more in!ormation
7nlinehumanservices.gov.auhealthpro!essionals then Incentives and Allo"ances @ Practice Incentives
Program
4mail pipAhumanservices.gov.au
!all 1700 222 032:: 9.3. am to 0... pm, &onday to Friday, ustralian !entral (tandard Time
8Call charges appl&.
88 Call charges appl& !rom mobile and pa& phones onl&.
;isclaimer
These guidelines are for information purposes and provide the basis on $hich PIP payments are made. ;hile it is
intended that the ustralian Government $ill ma%e payments as set out in these guidelines, the ma%ing of payments is
at its sole discretion. The ustralian Government may alter arrangements for the Practice Incentives Program or the
Practice Incentives Program General Practitioner ged !are ccess Incentive at any time and $ithout notice.
The ustralian Government does not accept any legal liability or responsibility for any in<ury, loss or damage incurred
by the use of, reliance on, or interpretation of the information provided in these guidelines.
19,2.,3.9