Payment recovery for Practice Incentives Program (PIP) and Workforce Incentive Program (WIP) - Practice Stream 012-10010100

Is the recovery for a payment quarter since 2018 and PIP After Hours Incentive, Procedural GP payment, or WIP - Practice Stream?

• Yes, email Incentives Recoveries to check if the practice is subject to audit or compliance activity by Department of Health and Aged Care (DoHAC). Include:
• practice name
• practice ID
• GP name/s for Procedural GP Payments
• GP name and provider number for ACAI
• reason for the overpayment
• period of the overpayment
• amount of the overpayment
• eHealth Incentive amount paid (if applicable)
• No, go to Step 3

Is the overpayment quarter/s since 2018 and for PIP After Hours Incentive, Procedural GP Payment or WIP - Practice Stream?

• Yes, email Program Management and confirm:
• which incentive the recovery is for
• how Services Australia was notified
• the impacted payment quarters and amount of recovery
• the date the practice became ineligible for the incentive or payment tier/level
• if the practice was eligible for a lower payment tier/level
• for Procedural GP payments, the name of the GPs
• No, return to the Service Officer for action

Policy will confirm the below:

• If the practice is subject to a general audit
• Pend the Work Item in PaNDA and wait for the audit results
• Procedure ends here
• If the practice is subject to an eHealth Incentive compliance review
• Pend the Work Item in PaNDA and wait for the audit results
• Procedure ends here
• The amount to recover for PIP and/or WIP - Practice Stream. Go to Step 3

If the overpayment relates to the GP Aged Care Access Incentive (GP ACAI):

• Program Management (Payments team) will confirm the amount to recover, or
• The practice will submit a correspondence detailing the overpayment

Once the GP ACAI recovery amount is advised, go to Step 3.

Download the Practice Incentives Overpayment information and summary sheet (IP032) from the Resources page.

Using the information on the practice profile, key the below details into the IP032:

• PIP and/or WIP - Practice Stream practice ID at Questions 1 and 2
• Practice name at Question 3
• Name of ownership entity (individual proprietor or company name) at Question 3 (practice recovery only)
• Date of lodgement at Question 5
• Provider number at Question 6 (if applicable)
• Provider name at Question 7 (if applicable)

For practice overpayments, the debtor is the owner/s of the practice. All correspondence and notifications must list the owner/s of the practice as the debtor.

The owner/s names can be found on the Ownership details screen in PIP and/or WIP - Practice Stream online

Key the below details for the debtor:

• Full name at Question 8
• Postal address at Question 9
• Daytime and Mobile phone number (if applicable) at Question 10
• Email address if available/known

Specify the reason(s) for the recovery at Question 11.

Select the right tick box and key the below details:

• Practice closure:
• Practice name - closed practice
• Date the practice ceased operating
• Go to Step 7
• Changes to practice eligibility:
• Details of eligibility criteria
• Date the practice’s eligibility details changed
• Go to Step 8
• Changes to individual incentive eligibility:
• Incentive tier level (if applicable)
• Details of incentive eligibility changes
• Date the individual incentive eligibility details changed
• Go to Step 8

If the above recovery reasons are not applicable, specify the reason(s) for the recovery at Question 14.

Key the date when PIP/WIP - Practice Stream Online was updated at Question 12.

Select/key the below details at Question 13:

• Program
• Payment Quarter
• Payment Year
• Overpayment amount
• Check if the overpayment includes teaching sessions. If the teaching sessions were provided prior to the date of closure/withdrawal this amount must be subtracted from the overpayment amount entered here
• RRMA and/or MMM classification. To find the classification:
• Select Practice Summary from the Main menu
• The RRMA or MMM classification is listed
• RRMA and/or MMM rural loading percentage:
• See Rural loadings percentages table on the Resources page
• Rural loading amount:
• PIP formula: total amount of overpayment x RRMA rural loading percentage
• If there are teaching sessions not being recovered, the rural loading for the teaching sessions must be calculated and subtracted from the total loading amount entered
• WIP - Practice Stream formula: total amount of overpayment x MMM rural loading percentage

The Total column will automatically calculate with the total overpayment amount.

Key any additional comments to assist the Recoveries Officer at Question 14.

If teaching sessions and associated rural loading payments have been excluded from the total overpayment amount record the details at question 14. The following information must be stated:

• The number of sessions
• Total teaching payment amount
• Associated rural loading amount

Key the below details at Question 15:

• Full name
• Operator number

Save the documents in:
G:INCENTIVESWORKFLOW/Recoveries/Practice Overpayment Details SA Staff

Use the naming convention:
Practice ID XXXXX_PROGRAM_SO Operator Number_Date,

For example, Practice ID 12345_PIP_P12345_23052024

Launch PaNDA desktop icon:

• Select PaNDA Document Upload tile under the DoHAC Services Menu
• Upload Type Field - select Create New Work Item using the drop down menu
• Document Upload - select Browse (pop up will display to select document)
• Date of Lodgement defaults to today’s date
• Program - select Incentives using the drop down menu
• Work Type - select Recovery/Voluntary Reimbursement for the relevant program using the drop down menu
• Case ID and Processing Notes may be added but are not mandatory
• Select Upload to submit the new work into the PaNDA allocation tool

Confirm the below details:

• practice details
• correct debtor
• overpayment quarters
• reason/s for the overpayment
• total amount to recover
• eligible teaching sessions not being recovered

Discuss any errors with the relevant Service Officer and return for correction.

Open the Debt Advice Notice (DAN) from:
G:INCENTIVESWORKFLOW/Recoveries/Recovery Letters and Forms

Key the below details:

• Debtor’s Name for a:
• practice recovery, individual proprietor or company name
• provider recovery, practitioner’s full name
• Practice No, practice ID
• Provider No (if applicable)
• Debtor’s Mail Contact Address (Postal Address)
• practice recovery, key the authorised contact person’s name if a company name has been keyed as the Debtor’s Name
• Telephone (BH) (daytime phone number)
• Mobile (if applicable)
• Email (if applicable)

Key the below details:

• Total amount of debt
• Amount for this Financial Year (including general ledger (GL) codes)
• Rural loading for this Financial Year (including GL codes)
• Amount for previous Financial Year (including GL codes)
• Justification of/Reasons for Debt
• Background, additional comments to assist the Recoveries Officer

The GL Codes are at
G:INCENTIVESWORKFLOW/Recoveries/General Ledger Codes

Key the below details:

• Prepared by (operator’s name)
• Date

Save the documents in:
G:INCENTIVESWORKFLOW/Recoveries/Practice Overpayment Details SA Staff

Use the naming convention:
Practice ID XXXXX_PROGRAM_SO Operator Number_Date,

For example, Practice ID 12345_PIP_P12345_23052024

Send the relevant overpayment letter(s) below to the debtor(s).

• PIP: Recovery of PIP payments (Z1844) letter
• WIP - Practice Stream and/or PNIP: Recovery of WIP - Practice Stream and PNIP payments (Z1669) letter
• SIP ACAI: escalate to Program Management (Policy) for a free text letter

See Letters for PIP and WIP - Practice Stream for help.

Save the letter:

• Select File > Save As
• Select a secure folder
• Rename the File name as the practice ID
• Select PDF (*.pdf) from the Save as type drop down > Save

Merge the below documents in the below order:

• Overpayment information and summary sheet (IP032)
• Debt Advice Notice (DAN)
• Overpayment letter

Add a comment to the practice profile.

• Select Comments from the Main menu
• The Comments screen displays

Under Add new comment:

• Select/key the below details:
• Area: Eligibility
• Reason: Other
• Comments: Payment recovery for ‘Payment Quarter’ and ‘Incentive type’ for the amount of ‘Overpayment amount’. Sent to Medicare debt recovery DD/MM/YYYY
• Select Add comment

Add a comment to PIP Online and WIP - Practice Stream Online if the recovery relates to the PIP and the WIP - Practice Stream.

Engage a second Recovery Officer to quality check the merged documents.

Amend the documents if there is an error.

Email the documents to Medicare Debt Recovery from the payment incentive recoveries email box.

Move the recovery documents to:
G:INCENTIVESWORKFLOW/Recoveries/Practice Overpayment Details SA Staff/Actioned

Record the recovery details in the Recovery Statistics spreadsheet:
G:INCENTIVESWORKFLOW/Recoveries/Statistics

For a practice recovery:

• Upload the overpayment correspondence to the practice profile
• If the recovery relates to PIP and WIP - Practice Stream, and the practice is not PIP consenting, upload to both profiles
• Do not upload the IP032 and DAN
• Finalise the work item as Complete in PaNDA

For a GP ACAI recovery:

• Add a processing note in PaNDA noting the documents have been saved to the actioned Recoveries folder
• Finalise the work item as Complete in PaNDA

Is the reimbursement for a payment quarter since 2018?

Note: voluntary reimbursements for incentives other than After Hours Incentive, Procedural GP Payment or WIP - Practice Stream do not need to be escalated for a compliance check.

• Yes, see Step 1 in Table 1
• No, go to Step 2

Log on to these systems:

• PIP Online, and/or
• WIP - Practice Stream Online

On the Practice Search screen:

• Key the Practice ID
• Select Search. The Search Results will show
• Select the practice ID hyperlink

The Practice Summary screen will show.

Open the Debt Advice Notice (DAN) from:
G:INCENTIVESWORKFLOW/Recoveries/Recovery Letters and Forms

Key the below details:

• Debtor’s Name, for a:
• practice recovery, individual proprietor or company name
• provider recovery, practitioner’s full name
• Practice No, practice ID
• Provider No (If applicable)
• Debtor’s Mail Contact Address (Postal Address)
• Practice recovery, key the authorised contact person’s name if a company has been keyed in the Debtor’s name field
• Telephone (BH) (daytime phone number)
• Mobile (If applicable)
• Email (If applicable)

Key the below details in the appropriate fields:

• Total amount of debt (total amount of Overpayment)
• Amount for this Financial Year (including general ledger (GL) codes)
• Rural loading for this Financial Year (including GL codes) (if applicable)
• Amount for previous Financial Year (including GL codes)
• Justification of/Reasons for Debt
• Background (additional information if required)

The GL Codes are at:
G:INCENTIVESWORKFLOW/Recoveries/General Ledger Codes

Key the below details:

• Prepared by (operator’s name)
• Date

Save the documents in:
G:INCENTIVESWORKFLOW/Recoveries/Voluntary Reimbursement

Use the naming convention:
PIP/WIP - Practice Stream practice ID XXXXX_PROGRAM_P######_Date.

For example, Practice ID 12345_PIP_P12345_23052024

Review the voluntary reimbursement notification.

Determine if the total overpayment amount is received by cheque.

Is the cheque for the total overpayment amount?

• Yes, go to Step 8
• No, and the cheque amount is:
• less than the total overpayment amount, go to Step 7
• more than the total overpayment amount, go to Step 8

Send the appropriate overpayment letter to the debtor.

• PIP: Recovery of PIP payments (Z1844) letter
• WIP - Practice Stream and/or PNIP: Recovery of WIP - Practice Stream and PNIP payments (Z1669) letter
• GP ACAI: escalate to the Program Management (Policy team) for a free text letter

See Letters for PIP and WIP - Practice Stream for help.

Save the letter:

• Select File > Save As
• Select a secure folder
• Rename the File name as the practice ID
• Select PDF (*.pdf) from the Save as type drop down > Save

Request a free text letter to confirm the overpayment and to acknowledge the reimbursement to the debtor.

• PIP: Recovery of PIP payments (Z1844) letter
• WIP - Practice Stream and/or PNIP: Recovery of WIP - Practice Stream and PNIP payments (Z1669) letter
• GP ACAI: free text letter from Program Management (Policy team)

See Letters for PIP and WIP - Practice Stream for help.

Save the documents:

• Select File > Save As
• Select a secure folder
• Rename the file name as the practice ID
• Select PDF (*.pdf) from the Save as type drop down > Save

Complete the Medicare receipt book.

The Medicare receipt book will create 3 receipts:

• Original receipt, attach this to the Voluntary Reimbursement Acknowledgement letter and send to the debtor
• Blue receipt, send this to Medicare Debt Recovery in Step 13
• Pink receipt, leave this in the Medicare receipt book

Get approval and a signature on the receipt by a Team Leader.

Scan and merge the documents in the below order:

• DAN
• Overpayment letter (if the cheque amount is less than the total overpayment amount only)
• All correspondences from the practice/provider
• Cheque
• Signed receipt (Blue receipt)
• Voluntary Reimbursement Acknowledgment letter

Do not merge internal emails.

Add a comment to the practice profile.

Select Comments from the Main menu to view the Comments screen. Under Add new comment:

• Select/key the below details:
• Area: Eligibility
• Reason: Other
• Comments: Voluntary reimbursement for ‘Payment Quarter’ and ‘Incentive type’ for the amount of ‘Overpayment amount’. Sent to Medicare debt recovery DD/MM/YYYY
• Select Add comment

Add a comment to PIP Online and WIP - Practice Stream Online if the recovery relates to the PIP and the WIP - Practice Stream.

Engage a second Recovery Officer to quality check the merged documents.

Amend the documents if there is an error.

Email the below merged documents to Medicare Debt Recovery from the Payment incentive recoveries mailbox:

• DAN
• Overpayment letter (if the cheque amount is less than the total overpayment amount only)
• All correspondences from the practice/provider
• Cheque
• Receipt (Blue receipt)
• Voluntary Reimbursement Acknowledgment letter

Job stream all documents to Medicare Debt Recovery in the above order.

Include all overpayment details including whether the voluntary reimbursement was less or more than the total overpayment amount.

Move the recovery documents to:
G:INCENTIVESWORKFLOW/Recoveries/Voluntary Recoveries/Overpayment Details SA Staff/Actioned

Record the recovery details in the Recovery Statistics spreadsheet:
G: INCENTIVESWORKFLOW/Recoveries/Statistics

Upload all recovery documents to the practice profile.