Enquiry management for Practice Incentives Program (PIP) and Workforce Incentive Program (WIP) - Practice Stream 012-10010140

Amendment

Notice of change

Spelling or data entry errors (not changes) to:

• Practice name
• Authorised contact/s
• Street name or type
• Company name
• Trading name
• Ownership address

• Can be advised over the phone or in writing
• A security check must be passed for verbal notifications
• For verbal notification, call details must be documented in a profile comment
• Written notification can be by HPOS email or on practice letterhead
• Must be signed by an owner or authorised contact person
• HPOS messages from a RA linked to the practice profile can be accepted as ‘signed’ by the sender

Correcting or amending:

• Phone and/or fax number
• Email address
• Postal address
• Incorrect street type (for example, road, avenue, crescent, etc.)

• Email or practice letterhead advice by practice
• Must be signed by an owner or authorised contact person
• HPOS messages from a RA linked to the practice profile can be accepted as ‘signed’ by the sender

Correcting, amending or changing an existing:

• owner’s name
• authorised contact name

• Email or practice letter head advice by contact or owner
• Must be signed by the owner or authorised contact person
• HPOS messages from a RA linked to the practice profile can be accepted as ‘signed’ by the sender.

If notifying a change of name, the notification must include both former and new names

Note: authorised contact names cannot be amended in PIP or WIP - Practice Stream online. The authorised contact details must be removed and re-added.

See: Authorised contact person changes for PIP and WIP - Practice Stream for more details.

Changes to the practice owners must be notified using the Practice Incentives Change of practice ownership form (IP010).

Changes to the authorised contact persons must be notified using HPOS or the Practice Incentives Change of practice details form (IP005).

Withdrawing from an individual incentive

Adding or updating an ABN

• Email or practice letterhead advice by practice
• Must be signed by an owner or authorised contact person
• HPOS messages from a RA linked to the practice profile can be accepted as ‘signed’ by the sender

Adding or changing a:

• company name
• trading name, or
• practice name

• Email or practice letterhead advice by practice
• Must state that it is not a change of ownership
• Must be signed by a practice owner/s. See Acceptable signature blocks for more information
• HPOS messages from a RA linked to the practice profile can be accepted as ‘signed’ by the sender
• Evidence to support the new details must be provided

Check associated documents for previously lodged evidence to confirm the changes.

Changes to the ownership structure or ownership type must be notified using a Practice Incentives Change of practice ownership form (IP010).

See also: Forms and letters for PIP and WIP - Practice Stream.

If practice is not relocating, changing the:

• unit number
• suite number
• street number
• lot number
• street name,
• or suburb of a practice

This can happen because of a council or government decision.

The practice must provide:

• A signed letter from the practice owner/s
• HPOS messages from a RA linked to the practice profile can be accepted as ‘signed’ by the sender
• Documents to support the change, such as a letter from the council
• An accreditation certificate that shows the correct address

See also,

Practice relocation for PIP and WIP - Practice Stream.

Screen

Updates

Authorised contact person update

Owner update

Form or supporting documents required

Ownership details

Date of change and add additional information

Yes

Yes

Yes

• IP010
• Evidence to confirm the change of ownership
• Evidence to confirm the ownership type

Locations

Relocate main/additional location

Yes

Yes

Yes

• IP005
• IP003
• Accreditation certificate

Incentive summary

Add/view teaching claims

Yes

Yes

No

• Completed and certified Teaching Payment claim forms (IP006) must be retained by the practice

IHI

Register/withdraw patient

Yes

Yes

No

• Completed and signed patient consent section of the IP017 must be retained by the practice

Item

Description

1

Question: What does this form mean?

Answer: All PIP/WIP - Practice Stream practices who wish to request a review of decision must complete the Practice Incentives Review of Decision (IP027) form.

Requests for a ROD should be lodged within 28 days of the original decision or notification.

2

Question: Can I ask for assistance from the Service Officer in writing my request for review of decision?

Answer: Service Officers can provide guidance on where to find the relevant program guidelines but cannot assist in the response. It is the practice’s responsibility to state their claim against the relevant program guidelines.

Giving false or misleading information is a serious offence.

3

Question: What am I required to do?

Answer: Practices must complete Practice Incentives Review of Decision (IP027) form. This includes:

• stating the reason(s) for the review against the relevant guidelines
• providing any supporting evidence that could assist their case (if applicable)

The complete form must be submitted to Services Australia within 28 days of receiving the decision to be reviewed.

The agency will review its decision in accordance with the PIP/WIP - Practice Stream eligibility criteria and/or payment formula. The agency will advise the practice in writing of the outcome once a decision has been made. Decisions are made on a case by case basis.

4

Question: What kind of evidence can I provide to support my Review of Decision?

Answer: Practices can provide various forms of evidence to help support their request for a Review of Decision. It is recommended that practices do this in the initial request. Types of evidence include:

• Fax receipts or telecommunication records
• Communication (faxes, letters, emails)
• Supporting letter/s explaining their appeal in further detail
• Legal documentation (for example, change of ownership documentation, letter from solicitor)

5

Question: If I am successful, how long will it take for my practice to get its payment?

Answer: If successful, the practice’s payment will be released as soon as possible.

Note: do not give a specific time frame for payment releases. Payments may not be released each fortnight.

6

Question: Can I use this form for Standardised Whole Patient Equivalent (SWPE) Calculation queries?

Answer: No. All SWPE calculation queries must go through to the Incentive Programs.

7

Question: Where can I find more information?

Answer: The PIP/WIP - Practice Stream guidelines contain information about program eligibility. For more information or to view the guidelines, go to the agency’s website.

Requested information

Conditions of release

Requests for basic information about participating practices, such as:

• Authorised contact/ownership details
• Accrediting body/accreditation status

Staff can give this information to MEOs.

Requests to confirm information about a practice’s participation in the program:

• if a practice has confirmed their Quarterly/Annual Confirmation Statements (QCS/ACS)
• if a practice is approved/on hold/withdrawn from the program
• if payments are being withheld
• if the practice is subject to compliance or payment recovery action

Staff can give this information to MEOs.

Requests to verify unconfirmed information about participating practices or providers, for example:

• speculation about a practice closure
• speculation about GPs ceasing employment at a participating practice

If the information does not match the practice profile:

• explain the information is unconfirmed
• all changes to practice details must come from an owner/authorised contact of the practice

Requests for copies of payment information or program information, for example:

• Quarterly/Annual Confirmation Statements (QCS/ACS)
• payment advices
• claims, letters or supporting documents

Escalate written requests from MEO to a Medicare Health Program Support Officer (PSO) for consideration by Program Management.

Requests for program-level reporting/data on multiple participating practices, for example SAS portal reports on:

• practices with withheld payments
• potential practice withdrawals
• incentive-based compliance activities

Escalate written requests from MEO to a Medicare Health Program Support Officer (PSO) for consideration by Program Management.

Requests for resources accessible to Service Officers working on Incentive programs. For example:

• Operational Blueprint files
• training modules, and
• agency education modules designed for practice managers/providers
• Health Professional Education

Self-serve access is available to all agency staff. Encourage MEO to use these resources to perform their routine activities.