What's new in PIP
PIP Cervical Screening Incentive
The screening target for the PIP Cervical Screening Incentive outcomes payment has increased from 50 per cent to 65 per cent of a practice’s eligible female patients.
The final PIP Cervical Screening Incentive outcomes payment to practices screening at least 50 per cent of their eligible female patients was made in May 2011. The first quarterly outcomes payments to practices who reach the new screening target of 65 per cent will be made in August 2011.
PIP GP Aged Care Access Incentive
On 1 July 2010, the two payment levels of the GP Aged Care Access Incentive (ACAI) increased as follows.
- The Tier 1 payment increased from $1000 to $1500 when the first qualifying service level (QSL 1) of 60 eligible MBS services is provided in Commonwealth-funded residential aged care facilities (RACFs), in 2010–11.
- The Tier 2 payment increased from $1500 to $3500 when the second qualifying service level (QSL 2) of 140 MBS services is provided in Commonwealth-funded RACFs in 2010–11.
The maximum payment a GP can receive in 2010–11 is $5000. To be eligible to receive the PIP GP ACAI payment, the GP must use a provider number that is linked to a PIP practice.
PIP Indigenous Health Incentive
The PIP Indigenous Health Incentive started in May 2010.
The PIP Indigenous Health Incentive targets Aboriginal and Torres Strait Islander patients aged 15 years and over with chronic disease and is part of the Council of Australian Governments (COAG) National Partnership Agreement on Closing the Gap: Tackling Indigenous Chronic Disease.
The PIP Indigenous Health Incentive supports general practices and Indigenous health services to provide better health care for Indigenous Australians, including best practice management of chronic disease.
The PIP Indigenous Health Incentive includes:
- a one-off payment of $1000 to practices and Indigenous health services that agree to undertake certain activities to improve care for Aboriginal and Torres Strait Islander patients
- an annual payment to practices and Indigenous health services of $250 for each eligible patient registered with the practice for chronic disease management
- annual payments to practices and Indigenous health services of up to $250 for each eligible patient for whom a target level of care is provided by the practice.
Administrative changes to the Practice Incentives Program
A range of administrative changes to the PIP are currently being implemented to reduce ‘red tape’ for practices currently participating in the program. The changes include:
- moving from prospective to retrospective payments for a number of PIP incentives
- the introduction of an annual Confirmation Statement process
- the implementation of an online administration system for PIP and General Practice Immunisation Incentive (GPII)
- the cessation of PIP recalculation payments.
Move to retrospective PIP payments
The move to retrospective PIP payments will ensure accuracy of payments to practices and eliminate the need for practices and GPs to estimate the services or activities they expect to provide in a future period.
The Procedural GP, Practice Nurse and After Hours incentives will move from prospective to retrospective payments.
Procedural GP Payment
The Procedural GP Payment has changed from a quarterly prospective payment to a six monthly retrospective payment. The final quarterly prospective payments were made to practices in November 2009 for procedural service activity in the period 1 November 2009 to 31 January 2010.
The first six monthly retrospective payments were made in August 2010 for procedural service activity in the period 1 January 2010 to 30 June 2010.
The next six monthly payments were made in February 2011, for procedural service activity in the period 1 July 2010 to 31 December 2010.
The requirements and payment levels for the Procedural GP Payment have also been revised to reflect the new six monthly reference periods.
To be eligible for the August six monthly payment, Procedural GPs must provide the required number of services relevant to the Tier they are participating in during the preceding six month reference period 1 January to 30 June.
To be eligible for the February six monthly payment, Procedural GPs must provide the required number of services relevant to the Tier they are participating in, during the preceding six month reference period 1 July to 30 December.
Medicare Australia has written to PIP practices to advise of this change.
Practice Nurse Incentive
Payments for the Practice Nurse incentive will change from quarterly prospective payments to quarterly retrospective payments.
The final quarterly prospective payments were made in May 2011 for the period 1 May 2011 to 31 July 2011.
The first quarterly retrospective payments will be in November 2011 for the period 1 August 2011 to 31 October 2011.
Payment schedule for the Practice Nurse Incentive
| Quarterly calculation | Type of payment | Period covered |
|---|---|---|
| May 2011 | Prospective payment | 1 May 2011 to 31 July 2011 |
| August 2011 | No payments will be made | N/A |
| November 2011 | Retrospective payment | 1 August 2011 to 31 October 2011 |
Medicare Australia wrote to all PIP practices regarding the Practice Nurse Incentive in May 2011 to provide more information on this change.
After Hours Incentive
Payments for the After Hours Incentive will change from quarterly prospective payments to quarterly retrospective payments.
The final quarterly prospective payments will be made in May 2012 for the period 1 May 2012 to 31 July 2012.
The first quarterly retrospective payments will be made in November 2012 for the period 1 August 2012 to 31 October 2012.
Payment schedule for the After Hours Incentive
| Quarterly calculation | Type of payment | Period covered |
|---|---|---|
| May 2012 | Prospective payment | 1 May 2012 to 31 July 2012 |
| August 2012 | No payments will be made | N/A |
| November 2012 | Retrospective payment | 1 August 2012 to 31 October 2012 |
Medicare Australia will write to all PIP practices participating in the After Hours Incentive in early 2012 to provide more information on this change.
Confirmation Statement
The purpose of the PIP Confirmation Statement is to confirm a practice’s ongoing eligibility for the PIP and individual incentives and to ensure the accuracy of PIP payments. The Confirmation Statement is generated based on the information practices have previously provided to Medicare Australia for the purposes of participating in the PIP.
The PIP Confirmation Statement process started in May 2010.
Medicare Australia writes to practices in May each year and provides a pre-populated Confirmation Statement containing information regarding ongoing eligibility for each PIP incentive that the practice is registered for. The practice's authorised contact person must check the accuracy of the information contained in the Confirmation Statement.
If the details in the Confirmation Statement are correct, the authorised contact person must return the completed and signed Incentives participation page of the Confirmation Statement to Medicare Australia (by mail, fax or scanned email) on or before 31 July each year. Alternatively, practices can complete the Confirmation Statement process through the PIP and GPII Online administration system.
If the information in the Confirmation Statement is incorrect the authorised contact person must contact Medicare Australia as soon as possible to update the practice’s details. Medicare Australia will forward the relevant form(s) to the practice. The relevant form(s) and the completed and signed Incentives participation page must be returned to Medicare Australia on or before 31 July for the practice to be eligible for the August quarterly payment. Any changes made directly onto the Confirmation Statement will not be accepted.
Medicare Australia will withhold the August quarterly payment for practices that fail to advise the accuracy of the Confirmation Statement, or fail to update any incorrect information by 31 July. Practices that do not return their Confirmation Statement by 31 October will have their August and November PIP payments placed on hold. Practices that do not return their Confirmation Statement by 31 January will have their August, November and February PIP payments placed on hold and will be withdrawn from the PIP as per the three quarter rule. These practices may also be subject to a Medicare Australia PIP audit.
Online administration
Practices can use the online administration system to apply for the PIP and/or GPII electronically, rather than completing a paper-based application form. Practices can also apply for new PIP incentives, review their PIP payments, maintain practice and provider details and receive information updates from Medicare Australia via the online system, thereby reducing ‘red tape’ and saving practices valuable time.
Medicare Australia wrote to all PIP and GPII practices in September 2010 to provide information on how to access and use the PIP and GPII online administration system.
Individual Public Key Infrastructure (PKI) certificates will be required by all practice owners, authorised contact people and providers to access PIP and GPII Online through Health Professional Online Services (HPOS).
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Last updated: 10 June, 2011