Practice Nurse Incentive Program (PNIP)
What is the Practice Nurse Incentive Program?
The Practice Nurse Incentive Program (PNIP) starts on 1 January 2012 and provides incentive payments to practices to support an expanded and enhanced role for nurses working in general practice.
The PNIP simplifies financing arrangements by consolidating funding arrangements under the Practice Incentive Program (PIP) Practice Nurse Incentive and six of the Medicare Benefits Schedule (MBS) practice nurse items and redirecting them into a single payment to eligible general practices.
General practices across Australia, including those in urban areas as well as Aboriginal Medical Services and Aboriginal Community Controlled Health Services may be eligible for an incentive to offset the costs of employing a practice nurse. One of the eligibility requirements is that your practice is accredited under the current Royal Australian College of General Practitioners (RACGP) Standards for general practice.
The program is administered by Medicare Australia on behalf of the Department of Health and Ageing
(DoHA) and the Department of Veterans’ Affairs (DVA).
Payments will be paid to eligible general practices that apply for the PNIP. Practices not eligible for incentive payments under the PNIP may be eligible for grandparenting payments if they are financially disadvantaged by the removal of the six MBS practice nurse items.
The program will also include:
- support for all accredited practices to employ an Aboriginal Health Worker instead of, or in addition to, a practice nurse (Registered Nurse or Enrolled Nurse)
- support for practices in urban areas of workforce shortage and Aboriginal Medical Services and Aboriginal Community Controlled Health Services to employ an allied health professional, such as a physiotherapist, dietitian or occupational therapist, instead of, or in addition to a practice nurse and/or Aboriginal Health Worker
- a rural loading of up to 50 per cent based on the Australian Standard Geographical Classification—Remoteness Areas (ASGC—RA)
- a loading for Aboriginal Medical Services and Aboriginal Community Controlled Health Services
- a one-off $5000 incentive to support eligible non-accredited practices to become accredited.
More information on the PNIP can be found in the Practice Nurse Incentive Program Guidelines.
PNIP—privacy and consent
PNIP needs practices and general practitioners (GPs) to give their consent for a number of program components. This information explains why consent is needed and the consequences if it's not provided.
Any practice participating in the Practice Incentives Program (PIP) can consent to the Department of Human Services (the Department) using its practice information, including its Standardised Whole Patient Equivalent (SWPE) for the purposes of PNIP.
GPs at the practice also need to give consent for the Department to use their Medicare Benefits Schedule (MBS) billing data or service data for some PNIP calculations.
Privacy and consent
The Department cannot use information supplied for the PIP for the purposes of the PNIP without your consent as this would not meet the Department's obligations under Section 14, Information Privacy Principles of the Privacy Act 1988 (the Act), specifically Principle 2 - Solicitation of personal information from the individual concerned (IPP2) and Principle 10 – Limits on use of personal information (IPP10).
In accordance with IPP2 the original privacy note on the PIP and GPII application form, expressly states the original purposes for the collection of the information:
Privacy note
The information on this form will be used to assess the practice's eligibility to receive payments under the PIP and/or the GPII and is required by Medicare Australia to perform functions under service arrangements made under the Medicare Australia Act 1973. Information, including personal information, provided on this form may be disclosed to the Department of Health and Ageing, other relevant agencies or as authorised or required by law.
In accordance with IPP10 of the Act the Department cannot use information for a purpose other than that for which it was collected, unless the individual the information relates to provides consent for that use.
Consent from a PIP practice
Giving consent lets PIP information be used for a purpose other than that for which it was collected:
- The Department can use the practice's SWPE already in use for the PIP, and
- The Department can use the practice details provided for the PIP.
The PNIP Online application process will auto fill all these details including summary details of the current GPs.
PIP practice details consent
When a PIP registered practice provides consent for the PNIP they are consenting to the use of the following information:
- practice name and main address
- eligibility details such as accreditation, public liability insurance and indemnity insurance
- bank account details
- contact details
- location details
- ownership details
- GP summary details (name and provider number only—explicitly excludes provider consent)
- associated documents
- comments, and
- SWPE (for PNIP calculations).
Note: the use of provider information to calculate the PIP SWPE is summarised at practice level—the provider can't be identified. Therefore provider consent is not needed to use the practice SWPE.
GP consent
PIP registered practice
During the application process, when a PIP registered practice consents to the use of practice details for the purpose of PNIP, a list of GPs is displayed on PNIP Online. Each GP needs to provide consent for the practice to use their MBS billing data for financial disadvantage assessment for top-up payments. Top-up payments are based on income earned from the six practice nurse MBS items and where relevant bulk bill incentive items, rendered in the historical period 1/08/2010 to 31/07/2011.
Note: consent is only required for this purpose when the GP worked at the practice during the period 01/08/2010 to 31/07/2011. If the GP start date at the practice is on or after 01/08/2011 consent is not required because the GP will not be included in the calculation of financial disadvantage.
If a practice cannot or chooses not to provide the consent of all of the historical GPs, the Department can still assess the practice for a top-up payment, but the assessment will only based on the MBS service data of the consenting GPs. A GP can give consent at any time (noting the deadline for applying for a top-up payment is 30 June 2012) and the MBS service data will be included in the calculation for the practice's next payment.
While all current GPs will auto fill in the GP details summary, any GP who worked at the practice during the historical period and has since left will need to be added to the GP details summary by the practice. The practice can then indicate whether the provider will be giving consent through PNIP Online, HPOS email, by fax or by post.
If a PIP registered practice only wants to be assessed for the incentive payment and not top- up payments, historical GPs do not need to be added to the GP details summary screen or to the paper based PNIP application form.
Non-PIP registered practice
A practice that is not registered for PIP will need to provide the consent of its current GPs to use the GP's data in the PNIP SWPE calculation. This SWPE value impacts the level of incentive payment the practice will receive.
If the GP does not consent, the practice's PNIP SWPE will be based on the GPs who have provided consent for the use of their MBS service data.
A GP at a practice not registered for PIP will also need to provide consent so the Department can do a financial disadvantage assessment for grandparenting payments. Grandparenting payments are based on income earned for the six practice nurse MBS items and where relevant the bulk bill incentive items, rendered in the historical period 1/08/2010 to 31/07/2011.
If a practice can not or chooses not to provide the consent of all of the historical GPs, the Department can still assess the practice for grandparenting, but the assessment will only be based on the consenting GPs. A GP can give consent at any time (noting the deadline for applying for a grandparenting payment is 30 June 2012) and the MBS service data will be included in the calculation for the practice's next payment.
If a non-PIP registered practice only wants to be assessed for the incentive payment and not grandparenting payments, historical providers are not required to be added to the GP details summary screen or to the paper based PNIP application form.
Annual Department of Veterans' Affairs (DVA) loading
A GP must provide consent for their MBS service data for services provided to DVA Gold Card holders to be included in the calculation of the practice's annual DVA loading.
If the GP does not provide consent to the use of their MBS service data information, those DVA services can't be included in the calculation of the DVA loading.
Quarterly confirmation statements (QCS)
If a GP does not provide consent they will not be listed on the practice's QCS. Information on the QCS is contained in the Practice Nurse Incentive Program Guidelines available on the Medicare website.
Frequently asked questions
I know my practice is not financially disadvantaged. Do I need to provide the consent of my GPs (current and historical)?
You will need the consent of your current GPs if you want to receive the DVA loading and have them listed on your QCS.
The consent of the historical GPs is only needed for your practice to be assessed for financial disadvantage.
I am a PIP registered practice—what happens if I do not provide consent on the PNIP eligibility check screen or at question 4 on the application form?
Without the practice's consent none of the practice details, including the SWPE and GP summary details, can be used and a start up SWPE of 1000 will be allocated to the practice.
PNIP payments
There are five payment types under the PNIP.
Incentive payment
The level of incentive payment a general practice will be entitled to depends on the practice’s Standardised Whole Patient Equivalent (SWPE) value and the hours worked by practice nurses at the practice.
The PNIP will provide incentive payments to eligible practices of:
- $25 000 per year, per 1000 SWPE where a Registered Nurse works at least 12 hours 40 minutes per week
- $12 500 per year, per 1000 SWPE where an Enrolled Nurse works at least 12 hours and 40 minutes per week.
Incentives will be capped at five per practice, meaning that practices will be eligible to receive up to $125 000 per year to support their practice nurse workforce. More information on the calculation of payments can be found in the Practice Nurse Incentive Program Guidelines.
To be eligible to receive the incentive payment, a practice must:
- meet the RACGP definition of a general practice
- be accredited or registered for accreditation against the RACGP Standards for general practice and be fully accredited within 12 months of joining the PNIP
- maintain practice accreditation
- have current public liability insurance
- make sure all practice GPs have current professional indemnity cover
- employ or otherwise retain the services of eligible practice nurses (PN) and/or Aboriginal Health Workers (AHW) and/or allied health professionals (AHP)
- employ or retain the services of a GP (including less than one full-time GP)
- make sure all PNs, AHWs and AHPs are covered by the appropriate professional indemnity insurance arrangements required by the Australian Health Practitioner Regulation Agency (AHPRA) or by the professional’s registration body.
Top-up payment
Top-up payments will be available for accredited practices receiving the incentive payment for the first three years of the program (from 1 January 2012 to 31 December 2014) to make sure that practices are not financially disadvantaged by the end of the PIP PNI and/or the six removed MBS practice nurse items.
Medicare Australia will assess if a practice is eligible for a top-up payment. These payments will be made quarterly at the same time PNIP incentive payments are made.
Practices will be required to provide practice details and current PIP practices will need to consent to the use of their PIP PNI data to calculate the top-up payment. Practices must supply the total contracted hours per week, by health professional type, for each quarter in the 12 month period of 1 August 2010–31 July 2011. Practices must also provide the relevant GP provider numbers for all GPs who worked at the practice during the historical period. Relevant GPs must also provide consent for Medicare Australia to use their MBS billing data in order to determine the practice’s eligibility and payment amounts.
Practices will have until 30 June 2012 to apply for a top-up payment. After this date, no applications will be accepted. Practices that apply for top-up payments after 1 January 2012 but before 30 June 2012 will have their payments backdated to 1 January 2012, or the earliest calculated eligibility date
Grandparenting payment
Grandparenting payments will be available for non-accredited practices that are not eligible for the incentive payment, for the first three years of the program (from 1 January 2012 to 31 December 2014) to make sure practices are not financially disadvantaged by the removal of the six MBS practice nurse items.
Medicare Australia will assess if a practice is eligible for grandparenting payments.
These payments will be made quarterly at the same time PNIP incentive payments are made.
Practices must supply the total contracted hours per week, by health professional type, for each quarter in the 12 month historical period (1 August 2010–31 July 2011). Practices must also provide the relevant GP provider numbers for all GPs who worked at the practice during the historical period. Relevant GPs must also provide consent for Medicare Australia to use their MBS billing data in order to determine the practice’s eligibility and payment amounts.
Practices will have until 30 June 2012 to apply for grandparenting payments. After this date, no applications will be accepted. Practices that apply for grandparenting payments after 1 January 2012 but before 30 June 2012 will have their payments backdated to 1 January 2012.
Accreditation Assistance Incentive payment
To be eligible for the one-off Accreditation Assistance Incentive payment a practice must be registered for accreditation against the RACGP Standards for general practice and meet the other eligibility requirements as detailed in the Practice Nurse Incentive Program Guidelines. In addition, the practice must join the PNIP, provide proof of registration for accreditation and become accredited within 12 months of joining the PNIP.
Department of Veterans’ Affairs loading
Practices that are eligible for the PNIP and provide GP services to Department of Veterans’ Affairs Gold Card holders will be eligible for a yearly, per veteran payment. These practices will be identified by Medicare Australia and paid in August each year.
The Department of Veterans’ Affairs loading will be calculated by determining the number of Gold Card holders who receive an ‘in rooms’ consultation in an eligible practice during each year. An amount will be paid for each Department of Veterans’ Affairs Gold Card holder, regardless of the practice location, nursing qualifications or the number of nurses per practice. There are no limitations on the number of Department of Veterans’ Affairs loadings paid per practice.
Where a Gold Card holder chooses to use more than one practice each year, the Department of Veterans’ Affairs loading will be divided across the practices based on the percentage of total consultation fees paid.
Applying for PNIP
From 5 December 2011, practices can apply for the PNIP and supply supporting documentation though PNIP Online. Practices can also still apply using the PNIP application form.
To safeguard practice and GP information, PNIP Online will be available as part of the secure Health Professional Online Services (HPOS). HPOS offers improved access to Medicare Australia’s online services for health professionals through a single entry point.
When applying online, practices may need to supply extra information using the forms below.
External guide
An external user guide is now available to assist practices in completing the PNIP application form. Please view the Practice Nurse Incentive Program (PNIP) Online guide for further information.
To apply for payments through the PNIP Online system practice owners and authorised contact persons must have a Public Key Infrastructure (PKI) individual certificate to access the system. To register for a PKI individual certificate you need to complete an application form.
If practice owners, or authorised contact persons already have a PKI certificate and require assistance with installation, access or other technical difficulties they can contact the eBusiness Service Centre on 1800 700 199**.
Practice and GP information will be kept secure by limiting system access only to those persons who have a PKI individual certificate that has been linked to the practice. To do this, the PKI individual certificate’s unique (10 digit) Registration Authority (RA) number must be recorded against the practice’s PNIP Online system.
A practice that does not have internet or PKI individual certificate access through the HPOS may request a hardcopy of the application form by calling 1800 222 032**.
Business Development Officers
If you are experiencing difficulty using your PKI Certificate or aren’t sure where to begin, Medicare Australia has a network of experienced Business Development Officers (BDOs) in all states and territories that are available to help you.
BDOs can help you and your practice with PKI applications, installation and advice and face-to-face appointments. If you are interested in having a BDO visit your practice call 1800 700 199**
Practices with multiple locations
Practices with multiple locations can apply to join the PNIP as a single practice provided the eligibility requirements are met. Practices will need to nominate the main practice location when completing the PNIP application form. The main practice location should be the location that provides the highest number of MBS services each year. Additional practice locations are known as practice branches.
Practices with multiple practice branches will only be regarded as a single practice where one or more of the doctors practising at the main location also practices at one or more of the other locations. More information on practices with multiple locations is available in the program guidelines.
If you need any assistance completing the PNIP application form call 1800 222 032** 8.30am to 5.00pm Australia Central Standard Time, Monday to Friday.
Accreditation
Accreditation is available through two approved organisations, Australian General Practice Accreditation Ltd (AGPAL) and Quality Practice Accreditation Pty Ltd through the General Practice Australia (GPA) Accreditation plus program.
Under the accreditation process, practices initially register for accreditation and then undertake an accreditation cycle that involves:
- self-assessment against agreed standards
- peer review surveys (practice visits) of the practice's organisation and facilities
- a continuous quality improvement cycle.
A practice is considered accredited on successful completion of the peer review survey. It is the responsibility of the practice to notify Medicare Australia when they have been fully accredited.
Practices must be accredited within one year of the date they join the PNIP and maintain accreditation to remain eligible for the PNIP.
For more information on accreditation:
Australian General Practice Accreditation Ltd (AGPAL)
Call: 1300 362 111*
Website: Australia General Practice Accreditation website
Quality Practice Accreditation Pty Ltd
through the General Practice Australia (GPA) Accreditation plus program
Call: 1800 188 088*
Website: General Practice Australia website
Administration of payments
When are PNIP payments made?
Payments will be calculated and paid retrospectively on a quarterly basis.
Payments are made by Electronic Funds Transfer (EFT) to the account nominated by the practice in the application form and do not attract Goods and Services Tax (GST).
Medicare Australia will make the first payment in February 2012 to practices that are eligible for PNIP. Practices have from 1 October 2011 to 31 January 2012 to submit their PNIP application form to be assessed as eligible in order to receive the February 2012 payment.
As PNIP starts on 1 January 2012, the February 2012 payment will cover only the last month of the quarter (1 January 2012 to 31 January 2012). Payments will be calculated as normal and then the total amount will be divided by three resulting in an amount for the month.
To qualify for payments, practices must have lodged their application for the PNIP by the ‘point in time’ date. The ‘point in time’ date corresponds to the last day of the month before the next PNIP quarterly payment. The quarterly payment months, ‘point in time’ dates and payment periods are provided below.
| Quarterly payment month | ‘Point in time’ assessment of eligibility | Payment period |
| February | 31 January | 1 November to 31 January |
| May | 30 April | 1 February to 30 April |
| August | 31 July | 1 May to 31 July |
| November | 31 October | 1 August to 31 October |
Payments are calculated using Medicare Australia and DVA data that is linked to the provider numbers specified on the practice's application form and any subsequent amendments provided to Medicare Australia. If, for example, you do not provide Medicare Australia with details of new GPs, you will not receive payments associated with the services provided by these new GPs.
If a practice tells Medicare Australia that it has changed its circumstances, either as a result of the quarterly confirmation statement or separately by the practice within 14 calendar days of the change in circumstances, its payment will be calculated based on the updated details.
Data will be excluded if any of the GPs in a practice do not consent to the use of their data for the purposes of calculating the practice's payment when completing the PNIP Individual General Practitioner details form. If GPs would like their data to be included at a later stage, they must advise Medicare Australia in writing.
Calculating the SWPE value
PNIP payments are based on a measure of the practice size known as the Standardised Whole Patient Equivalent (SWPE) value. The SWPE value of a practice is the sum of the fractions of care provided to practice patients, weighted for the age and gender of each patient. The average full time GP has 1000 SWPEs per year.
If your practice is an existing PIP practice and you have provided consent for Medicare Australia to access your PIP information, the existing PIP SWPE value will be used in determining the SWPE value for the PNIP.
Newly established practices, practices not participating in the PIP or PIP practices that do not provide Medicare Australia consent to access their PIP information will not have a SWPE value and will be given an initial start up SWPE value of 1000.
It takes approximately six payment quarters (18 months) from the time of joining the PNIP to establish a full SWPE value. From then, the calculated SWPE value will be used, even if it is lower than 1000. If during the 18 month period the practice’s SWPE value is more than 1000, the actual SWPE value will be used to calculate payments.
Aboriginal Medical Services and Aboriginal Community Controlled Health Services
The SWPE values for Aboriginal Medical Services and Aboriginal Community Controlled Health Services will be increased by 50 per cent.
How are PNIP payments made?
Medicare Australia will provide quarterly confirmation statements to all practices receiving incentive, top-up or grandparenting payments. Practices are required to confirm their details are correct on the quarterly confirmation statement before the payment can be released to the practice.
Practices will receive their quarterly confirmation statement via the PNIP Online system. If a practice does not have access to PNIP Online, Medicare Australia will mail the practice’s confirmation statement.
If a practice does not complete and return the quarterly confirmation statement by the ‘point in time’ for eligibility assessment, the practice’s payment will be withheld.
Review of decision process
The PNIP has established a review of decision process. To request a review of decision, your practice’s authorised contact person or the owner/s of the practice must write to Medicare Australia within 28 calendar days of receiving the notice of the decision it would like reviewed.
The request must include the following details:
- the name and address of the person requesting the review
- the name and identification number of the practice
- the decision to be reviewed
- the grounds for requesting the review.
Medicare Australia will reconsider its decision following the PNIP eligibility criteria and/or payment criteria used to make the original decision and advise the practice in writing of the outcome of the review.
If a practice is not satisfied with the reviewed decision, the practice may request the decision to be considered by a formal review committee. Medicare Australia will make these decisions on a case-by-case basis.
For more information on the review of decision process call 1800 222 032** 8.30am to 5.00pm Australian Central Standard Time, Monday to Friday.
PNIP Incentive Payment Ready Reckoner
The Department of Health and Ageing and Medicare Australia have developed the ready reckoner below that can be used to estimate the incentive amount a practice may be entitled to.
PNIP Incentive Payment Calculator - Ready Reckoner (opens in a new window)
PNIP guidelines
Access the guidelines in either PDF or RTF format:
Practice Nurse Incentive Program guidelines [PDF, 967Kb]
Practice Nurse Incentive Program guidelines [RTF, 528Kb]
For more information on PNIP
Phone: 1800 222 032**
Website: www.medicareaustralia.gov.au/pnip
Email: pnip@medicareaustralia.gov.au
Mail: Practice Nurse Incentive Program, GPO Box 2572, ADELAIDE SA 5001
Fax: 1300 587 696
* Call charges apply.
**Call charges apply for mobile and pay phones only.
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Last updated: 6 January, 2012