Prescribed Pattern of Services (the 80/20 rule)

The 80/20 rule aims to address consistently high volumes of rendered services by general practitioners (GP) and other medical practitioners (OMP).

Page last updated: 05 July 2018

What you need to know

A GP or OMP engages in inappropriate practice if they have rendered or initiated 80 or more professional attendance services on each of 20 or more days in a 12 month period (known as a 'prescribed pattern of services'). This is commonly referred to as the "80/20 rule".

The 80/20 rule is based on the number of professional attendance services per day, which may not be the same as the number of patients seen in a day. GP and OMP professional attendance services include the following groups as listed in the Health Insurance (Professional Services Review) Regulations 1999:
  • A1 General practitioner attendances to which no other items applies
  • A2 Other non-referred attendances to which no other item applies
  • A5 Prolonged attendances to which no other item applies
  • A6 Group therapy
  • A7 Acupuncture
  • A9 Contact lenses - attendances
  • A11 Urgent attendances after hours
  • A13 Public health physician attendances to which no other item applies
  • A14 Health assessments
  • A15 GP management plans, team care arrangements and multidisciplinary care plans and case conferences
  • A16 No professional attendance items are currently listed in this Group
  • A17 Domiciliary and residential medication management reviews
  • A18 General practitioner attendances associated with Practice Incentive Program (PIP) payments
  • A19 Other non-referral attendances associated with PIP payments to which no other items applies
  • A20 Mental health care
  • A21 Medical practitioner (emergency physician) attendances to which no other item applies
  • A22 General practitioner after-hours attendances to which no other item applies
  • A23 Other non-referred after-hours attendances to which no other item applies.
We routinely monitor Medicare claims of all GPs and OMPs to identify those who are approaching or have exceeded the 80/20 level of servicing.

If you exceed the 80/20 level of servicing, you will be reviewed under the Practitioner Review Program (PRP).

The Health Insurance Act 1973 requires a request to be made to the Director of Professional Services Review (the Director) if the delegate of the Chief Executive Medicare (delegate) becomes aware of a breach of the 80/20 rule. Once the PRP has verified that the medical servicing data indicates that a breach of the 80/20 rule has occurred, and you have been contacted and the matter has been assessed by a delegate, a request will be made to the Director to review your provision of services.

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