MyMedicare Review of Decision – GPACI or BBPIP

When Things Don’t Go as Expected

If your practice is not satisfied with an outcome under MyMedicare, including the General Practice Aged Care Incentive (GPACI) or Bulk Billing Practice Incentive Program (BBPIP), there are several options available to help resolve the issue.

Many concerns, such as questions about incentive payment eligibility, missed payments, expired accreditation exemptions, or circumstances affecting program requirements, can often be addressed by contacting Services Australia for clarification or further investigation.

If the matter remains unresolved, the final option is to request a formal Review of Decision (RoD) Review of Decision Form (IP034). This article outlines the steps to take, when a review may be appropriate, and the information needed to support your request.

What to do first:

• In many cases, questions can be answered quickly by contacting Services Australia on 132 011 (option 2).
• Where additional support is helpful, enquiries can be escalated through Services Australia for further assistance.
• A request for review is a formal process and is usually the final recourse.

When to request a Review of Decision

• A RoD is a formal process and is generally the next step once the initial enquiry has been escalated and reviewed and the provider or practice remains dissatisfied with the outcome.
• To request a RoD, a completed form and supporting documentation must be provided to Services Australia.

 What practices need to know

• Taking early steps to seek clarification can often resolve questions quickly and may remove the need for a formal review.
• Maintaining clear documentation and records helps support any review request if one is required.
• RoD are separate process from initial enquiries and are managed through a formal review pathway.

Resources

Further information is available through Services Australia and the Department of Health,  Disability and Ageing websites.

• Program Guidelines
• Review of Decision Form (IP034)

For more information please contact practicesupport@cesphn.com.au or digitalhealth@cesphn.com.au and or visit the Australian Government website:
https://www.servicesaustralia.gov.au/mymedicare