Practice Incentives Program guidelines

Encourages general practices to continue providing quality care, enhancing capacity, and improving access and health outcomes for patients.

Eligibility

Eligibility for the PIP

To be eligible for the Practice Incentives Program (PIP) your practice must meet certain criteria.

Read more about PIP eligibility

PIP payment types

There are 3 types of payments under the PIP - practice payments, service incentive payments, and rural loading payments.

Practice payments

Most payments made through PIP are to practices. Practice payments are to contribute to quality care. This includes helping the practice to buy new equipment, upgrade facilities or increase pay for practitioners at the practice.

We’ll pay you if you meet the eligibility requirements of the incentives for the entire quarter. This includes the point in time date.

The point in time date is the last day of the month before the next PIP quarterly payment.

Service incentive payments

Service incentive payments (SIPs) recognise and encourage GPs to provide specific services to individual patients. We pay SIPs directly to GPs, into their nominated bank account.

The Cervical Screening, Asthma and Diabetes incentives have SIP components. The Aged Care Access Incentive is a SIP only.

Rural loading payments

To get the rural loading payments practices must:

  • be participating in the PIP
  • have the main practice located outside a capital city or other major metropolitan centre

We’ll automatically pay the loading, you don’t need to do anything.

We base the loading on the main practice’s location using the Rural, Remote and Metropolitan Areas (RRMA) Classification on the Australian Institute of Health and Welfare website, 1991 Census Edition (Department of Primary Industries and Energy and Department of Human Services and Health, November 1994).

How we calculate PIP payments

We base most payments on a measure of the practice size known as the Standardised Whole Patient Equivalent (SWPE) value.

Data from Medicare and the Department of Veterans’ Affairs (DVA) is used to calculate payments.

The data links to the provider numbers on the practice's PIP application, and any subsequent changes.

If, for example, a practice doesn’t give us details of new practitioners, the services provided by the practitioner won’t count towards the calculation of the practice’s SWPE value.

If a practice tells us it has changed its circumstances, we base the payment on the updated details.

Standardised Whole Patient Equivalent

The Standardised Whole Patient Equivalent (SWPE) value of a practice is the sum of the fractions of care provided to practice patients. This is weighted for the age and gender of each patient.

Read more about Standardised Whole Patient Equivalent

When we make PIP payments

To qualify for payments, practices must have submitted a completed application - including supporting documents - for the PIP at least 7 days before the relevant point in time date and meet all eligibility requirements of the incentives for the entire quarter, including the point in time date.

The point in time date is the last day of the month before the next PIP quarterly payment.

Payment months, point in time dates and reference periods
Quarterly payment month Point in time assessment of eligibility Reference period
February 31 January 1 November to 31 January
May 30 April 1 February to 30 April
August 31 July 1 May to 31 July
November 31 October 1 August to 31 October

Practices no longer participating in the program at the point in time date aren’t eligible to get the current quarter payment.

How we make PIP payments

We calculate payments and pay them retrospectively each quarter.

Read more about how we make PIP payments

Applying

Apply

To apply for the PIP your practice must be eligible. A practice owner can apply at any time, online or by form.

You can apply online or by form.

Online

Apply through Health Professional Online Services (HPOS) using your Provider Digital Access (PRODA) account.

Read more about PRODA including how to create an account.

By form

Complete the Practice Incentives application form and fax it to us with the required supporting documents.

Supporting documents

The practice must provide proof of accreditation. This can be either a certificate of accreditation or registered for accreditation from an approved accrediting agency.

Applications must be complete. We can’t accept incomplete applications.

Authorised contact person

The practice’s application must include the name and contact details of an authorised contact person. The contact person must be authorised by the owner of the practice. They’ll advise us of any changes and will be the person we send all correspondence or enquiries to. We can only contact the current owner or authorised contact person.

Practices must keep a copy of the application documents for at least 6 years.

Application outcome

We’ll assess your application and let your practice know in writing if it’s eligible.

If we ask for further information you need to provide it within 7 days of getting the request.

Managing

Your obligations for the PIP

Eligibility for payments under the Practice Incentives Program (PIP) depends on practices meeting their obligations for the PIP.

Keeping practice information up to date

The practice must:

  • be able to prove its claims for payment
  • provide accurate information to the Department of Health as part of their audit program to demonstrate the practice meets the PIP eligibility requirements
  • keep a copy of all documents relating to the PIP requirements for a minimum of 6 years
  • confirm all details in the annual confirmation statements are correct
  • tell us about changes to practice arrangements within 7 days or at least 7 days before the relevant point in time date, whichever date is first

Changes to practice arrangements can include:

  • practitioners leaving or joining the practice
  • changes to the authorised contact person for the practice
  • changes to the practice’s bank account
  • changes to practitioner’s bank account
  • changes in accrediting agency or accreditation status, such as the practice achieving accreditation or the accreditation lapsing
  • changes to the practice location, ownership or amalgamations
  • lapses in the practice’s public liability insurance or an individual practitioner’s professional indemnity cover
  • changes that affect eligibility for individual incentives
  • changes in practitioner details
  • extensions to provider numbers allocated by Medicare with an end date
  • any other information that may affect program eligibility

How to tell us about changes

The easiest way to tell us about any changes to practice arrangements is online through Health Professional Online Services (HPOS). You can use HPOS to let us know about changes up to, and on, the relevant point in time date. Most changes are immediate.

If you want to fax us the changes you need to do this at least 7 days before the relevant point in time date. You’ll need to complete the relevant form:

You can also tell us about minor changes to practice arrangements in writing. We must get this no later than 7 days before the relevant point in time date.

Withdrawing from the PIP

You can withdraw from the PIP at any time:

You need to do this by the point in time date for the quarter from which you no longer wish to get payments.

Practices that withdraw or are withdrawn from the PIP aren’t entitled to any withheld payments. Your practice will need to reapply for the PIP if you want to rejoin the program.

We’ll assess these practices as new applicants. They’ll need to be accredited to be eligible to participate.

Privacy and consent

Your personal information is protected by law (including the Privacy Act 1988) and is collected by the Australian Government Department of Human Services for the purposes of the Practice Incentives Program (PIP).

Your personal information will be disclosed to the Australian Government Department of Health to enable that department to administer aspects of PIP, including for program compliance purposes, for statistical and research purposes and to inform policy development.

Your personal information may be used by the Department of Human Services, or given to other parties where you have agreed to that, or where it is required or authorised by law (including for the purpose of research or conducting investigations).

You can get more information about the way in which the Department of Human Services will manage your personal information, including our privacy policy.

Rights of review

The Practice Incentives Program has a review of decision process. This is separate from reviews relating to program audits.

We base our decisions made under the program on the published guidelines as at the date of the event.

To request a review of a decision, the authorised contact person or the owners of the practice must write to us using the Practice Incentives review of decision form.

You must do this within 28 days of receiving the decision you want reviewed.

We’ll review our decision against the PIP eligibility criteria, the payment formula, or both. We’ll write to your practice to let you know the outcome of the review.

If you aren’t satisfied with the review decision, you can ask our Formal Review Committee to reconsider it. The Formal Review Committee is the last avenue of appeal and its decision is final.

Contact us to find out more about the formal review process.

Audits

The Department of Health (Health) conducts program audits to check practices are complying with the PIP eligibility requirements for payments.

This may include practice visits or a review of practice documents.

If your practice can’t provide information to substantiate your eligibility and claims for incentives, Health may recover past PIP payments for up to 6 years.

Evidence of eligibility may include:

  • copies of public liability insurance including amount covered
  • copies of professional indemnity insurance for all general practitioners and nurse practitioners
  • confirmation of details contained in the annual confirmation statements

Copies of the evidence should be kept on practice files.

If a practitioner leaves a practice and an audit is conducted for the time the practitioner was there, a practice will still need to provide evidence that the professional indemnity insurance was maintained during their employment.

Resources

PIP definitions

Some terms used in the Practice Incentives Program have specific meanings.

Read more about PIP definitions

Disclaimer

These guidelines are for information purposes and provide the basis upon which PIP payments are made. While it’s intended that the Australian Government will make payments as set out in these guidelines, payments are made at its sole discretion. The Australian Government may alter arrangements for the PIP at any time and without notice. The Australian Government does not accept any legal liability or responsibility for any injury, loss or damage incurred by the use of, reliance on, or interpretation of the information provided in these guidelines.

Page last updated: 18 October 2017