Eligibility for the PIP
To be eligible for the Practice Incentives Program (PIP) your practice must meet certain criteria.
To be eligible to participate in the Practice Incentives Program (PIP), a general practice must meet all the following requirements:
- meet the Royal Australian College of General Practitioners (RACGP) definition of a general practice
- meet the PIP definition of an open practice
- maintain at least $10 million in public liability insurance cover for the main location and each additional practice location. Legal liability is not public liability.
- make sure all general practitioners and nurse practitioners have the required minimum of $10 million professional indemnity insurance cover
- be accredited, or registered for accreditation as a general practice against the Royal Australian College of General Practitioners (RACGP) Standards for general practices (the Standards) – accreditation must:
- cover the entire quarter they’re applying in
- be maintained thereafter
- be registered for and achieve accreditation against the RACGP Standards within 12 months of joining the program, irrespective of any extensions obtained on their registered for accreditation certificate
Practices must be accredited, or registered for accreditation as a general practice, to participate in the Practice Incentives Program (PIP).
If registered for accreditation they must achieve accreditation within 12 months of joining the PIP as a general practice against the RACGP Standards. The standard must also be referenced on the certificate provided by the accrediting agency.
Practices must maintain their accreditation against the Standards thereafter.
If the practice doesn’t achieve accreditation within 12 months of joining the PIP, it won’t be eligible for any further payments.
The practice will become eligible for a payment once it has been accredited for an entire quarter. The practice isn’t entitled to any withheld payments for any period where they’re not accredited for the entire quarter.
Accrediting agencies must be approved under the National General Practice Accreditation Scheme (the Scheme) to accredit practices to participate in the PIP. The Scheme supports the consistent assessment of Australian general practices against the Standards.
A list of approved accrediting agencies is on the Australian Commission on Safety and Quality in Health Care website.
Some services aren’t eligible to get payments under the PIP.
Medical Deputising Services that directly arrange for medical practitioners to provide after hours medical services to patients of practice principals during the absence of, and at the request of, the practice principals aren’t eligible for PIP.
After hours medical services that provide care outside the normal opening hours of a general practice aren’t eligible for PIP. This applies whether or not:
- the service deputises for other general practices
- they provide care within or outside the practice
Practices with multiple locations
Practices with multiple locations can apply for the PIP as a single practice as long as they meet the eligibility requirements.
Practices need to nominate their main practice location. The main practice location must be the one that provides the most Medicare Benefits Schedule (MBS) services each year. Additional practice locations are practice branches.
To be eligible as a practice branch it must:
- provide MBS services
- have 1 or more general practitioners (GPs) who provide MBS services at both the main practice and the practice branch
- maintain at least $10 million in public liability insurance cover - legal liability isn’t public liability
- have and maintain current professional indemnity cover for all practitioners working there
Accreditation of practice branches
Practice branches need to be accredited to participate in the PIP if they provide 3,000 or more services each year. The quarterly payment advice shows how many services are provided by each location.
Practice branches don’t need to be accredited to participate in the PIP if they provide less than 3,000 services each year. We include these MBS services in the calculation of the practice’s PIP payments for the main location, regardless of whether they’re accredited.
Once a practice branch reaches 3,000 MBS services per year, they must register for accreditation in their own right. They’ll have 12 months to be assessed and achieve accreditation with an approved accrediting agency.
Transfer of accreditation
There are 2 scenarios where you can transfer your accreditation:
- relocation and
- sale of a practice
If an accredited PIP practice relocates, it will need a new accreditation certificate.
The practice will need to provide us with a copy of the new accreditation certificate within 6 months of relocating.
We’ll put practice payments on hold until the practice has given us an accreditation certificate showing the new location address. To be eligible to get any held payments, practices must ensure the new accreditation certificate begins from the date of relocation.
Sale of a practice
When a practice is sold, the new owner can’t be in the PIP using the historical data from the previous owner unless the practice accreditation was included in the sale of the practice.
If the new practice owner doesn’t have accreditation they’ll need to apply as a new practice.
Page last updated: 22 February 2019
This information was printed 21 July 2019 from https://www.humanservices.gov.au/organisations/health-professionals/services/medicare/practice-incentives-program-guidelines/eligibility/eligibility-pip. It may not include all of the relevant information on this topic. Please consider any relevant site notices at https://www.humanservices.gov.au/individuals/site-notices when using this material.