What you need to knowThis guideline outlines what you can do to substantiate the creation of a valid GP Management Plan for Medicare Benefits Schedule (MBS) item 721.
The guideline is not exhaustive and you can respond to a Medicare compliance audit or review using any documents you think substantiate the concern raised.
However, we may determine more information is needed and request additional documentation to substantiate services you have claimed.
Read the health professional guidelines about substantiating claims for Medicare compliance purposes before proceeding.
Documents you may use to substantiate a claimAny document you give us should have been created during or as soon as practicable after the treatment occurred. It should include the patient's name and the date the treatment was provided.
To substantiate that a valid GP Management Plan existed you may provide:
- a copy of a written plan - clearly showing the patient's name and information meeting all the requirements outlined in the MBS descriptor
Additional supporting evidence may include:
- an excerpt/s from the patient's clinical file - clearly showing the patient's name, the date of service and the date and a record of the patient's agreement to the preparation of a valid GP Management Plan
- a copy or excerpt of a document showing a review or amendment to a valid GP Management Plan has occurred - clearly showing the patient's name and the date of GP Management Plan review. This copy or excerpt should include all elements required to form a valid GP Management Plan review
In most cases, a patient's clinical information will be the only way to confirm that a specific service was provided, and substantiate you received the correct Medicare benefit.
If you need to use a patient's clinical information you can censor any details that aren't relevant. You can also choose to provide the information to one of our medical advisers.
- Health Insurance (General Medical Services Table) Regulation 2016
- MBS Online
- Administrative Record Keeping Guidelines for Health Professionals
- Health Professional Compliance