Incentive & Billing Optimisation

The Quality Improvement incentive is part of the Practice Incentives Program (PIP) and aims to incentivise practices who participate in quality improvement initiatives.

Currently to be eligible, practices are required to partner with their local Primary Health Network (PHN) and share de-identified data, called a PIP Eligible Data Set, with their local PHN each quarter. The requirement to partner with the local PHN to participate in quality improvement can consist of many different activities and is up to the practice as to what initiatives they would like to arrange or participate in. The PIP eligible data set that is shared each quarter contains de-identified data regarding 10 specified improvement measures.

Currently, payments are not affected by changes to the 10 specified improvement factors but are instead dependent on partnering with the local PHN and sharing of the eligible data set.

The incentive payment is based on the practice’s Standardised Whole Patient Equivalent (SWPE) and is paid at $5 per SWPE with a maximum payment of $50,000 per annum.

The Workforce Incentives Program – Practice Stream was formerly known as the Practice Nurse Incentives Program (PNIP) and will officially change over on February 1st 2020. The incentive aims to support an enhanced role for nurses and allied health care professionals.

The incentive payment is based on a practice’s SWPEs and is made up of 2 components:

$25,000 per annum per 1,000 SWPEs where a nurse practitioner, registered nurse (RN), or allied health professional works at least 12 hours and 40 minutes per week; and $12,500 per annum per 1,000 SWPEs where an enrolled nurse (EN), Aboriginal and Torres Strait Islander Health Worker and/or Aboriginal and Torres Strait Islander Health Practitioner works at least 12 hours and 40 minutes per week.

Aboriginal Medical Services (AMS) and Aboriginal Community Controlled Health Services (ACCHS) are eligible for a 50% increase in the SWPE for calculation purposes of this incentive.

A cap of $125,000 is applicable to this incentive payment, however a practice may be eligible for rural loading that may be applied in excess of the cap.

Payments are made quarterly and there are a number of requirements that need to be met in order to be eligible for each payment including making submissions to the Department each quarter.

The Workforce Incentives Program – Doctor Stream was formerly known as the General Practice Rural Incentives Program (GPRIP). The Doctor Stream aims to incentivise medical practitioners to practise in regional, rural and remote communities and to encourage long-term medical careers in such areas.

The incentive payment relates to individual GPs and considers the degree to which the location of the practice is rural or remote (using the Modified Monash Model) as well as consider the number of years that each GP has been enrolled on the program as seen below.

Payment Per GP

From January 1st 2020 this incentive will adopt the 2019 version of the Modified Monash Model (MMM) of remoteness. To find out what remoteness level your practice is classified as you can visit the Department of Health’s Health Workforce Locator.

Payments are made quarterly and there are a number of requirements that need to be met in order for the practice and each GP to be considered eligible for each payment.

The PIP Teaching Payment aims to incentivise practices who provide teaching sessions for medical students preparing to enter the medical profession in Australia. The payments are to compensate general practitioners and practices for the reduced potential of consultations due to the presence of students.

The incentive payment is based on the number of training sessions provided by individual GPs. Each participating GP must be individually registered for the incentive and each training session must be 3 hours in length. Payments of $200 for each 3 hour training session are paid quarterly if the Department of Human Services is notified of the sessions. There is no maximum number of GPs for an enrolled practice. However, the number of training sessions is capped at 2 per GP, per calendar day.

The GP Aged Care Access Incentive (ACAI) is a Practice Incentive Program (PIP) that aims to encourage GPs to provide increased and continuing services in residential aged care facilities.

The Aged Care Access Incentive requires participating GPs to be individually registered for the incentive and there is no minimum or maximum number of GPs that can be enrolled from a Practice.

The payment is based on the number of eligible MBS items that have been billed per GP and is paid in addition to MBS rebates.

Each enrolled GP may be eligible for 1 of 2 payment levels:

• 60 – 139 eligible services billed per annum ($1,500).
• 140 or more eligible services billed per annum ($3,500).

Despite initial communications regarding this incentive being ceased, the Federal Government has indicated in the 2019 budget that it will fund the aged care access incentive until at least 2024.

The PIP Indigenous Health Incentive aims to incentivise and support general practices and Indigenous health services provide better health care for Aboriginal and Torres Strait Islander patients. This incentive forms part of the Australian government’s ‘Closing the Gap’ strategy and specifically focuses on indigenous chronic disease.

The incentive payment is currently split into 3 payment categories. The first is a one-off $1,000 payment for registering into the program, the second is a $250 payment per registered patient and the third is an outcomes payment that can be up to $250 per registered patient.

There are a number of requirements that need to be met in order to be eligible for each payment. Payments are made quarterly and patients who remain on the program at the practice need to be re-registered each year. 

A review of the efficiency and effectiveness of this incentive was performed by the Department of Health in 2019, subsequently this incentive may be amended in 2020 and we will endeavour to keep our practices up to date with any changes.

 The eHealth PIP aims to encourage general practices to keep up to date with the latest developments in digital health and adopt new digital health technology as it becomes available.

The eHealth PIP currently incentivises practices who perform uploads of digital health records. The minimum number of uploads to be eligible for the incentive is dependent on a practice’s Standardised Whole Patient Equivalent (SWPE). Targets are currently set at 0.5% of the practice’s SWPE per quarter and the incentive is currently set at $6.50 per SWPE, capped at $12,500 per quarter. There are several requirements that a practice needs to have in place in order to remain eligible for the eHealth incentive.

The After Hours PIP incentivises general practices to provide their patients with access to after-hours care. This care can be delivered in a number of ways and can involve partnering with deputising services or other practices, can involve providing care directly from the practice, or a combination of telephone-based care, home visits and other methods.

There are 5 after hours incentive payment levels that correspond with the types of arrangements in place at the practice. Each payment level has a number of requirements that the practice needs to comply with in order to remain eligible for the incentive.

The PIP procedural GP payment encourages and incentivises GPs in rural and remote areas to provide access to surgical, anaesthetic and obstetric services.

Each participating GP must register for the payment individually and may be eligible for 1 of 5 payment tiers if eligibility requirements have been met.

Payments are made quarterly and practices must be in a Rural, Remote and Metropolitan Area (RRMA) 3–7 location in order to be eligible.

The rural loading PIP incentivises practising in more rural and remote areas and financially supports practices who work in such areas in recognition of the difficulties in providing care.

The loading is applicable to all other Practice Incentive Program payments, however is not applicable to Service Incentive Program payments or Workforce Incentive Program payments. The Workforce Incentive Program has its own individual loading for rural and remote locations, which utilises the Modified Monash Model (MMM) classification system.

Payments applicable to the rural loading PIP are made quarterly and practices must be in a Rural, Remote and Metropolitan Area (RRMA) 3–7 location in order to be eligible. The amount of loading is dependent on what RRMA location level the practice is classified under.

In the last 24 months have you employed someone? Bought or installed lighting in your practice? Bought or leased a commercial fridge or freezer? Employed staff in a rural area? Are you planning on purchasing hi-lo beds, bollards, security cameras or duress alarms? Do your staff wear uniforms? You could be eligible for several state or federal government grants, contact us today to find out more.