Health Insurance (Professional Services Review Scheme) Regulations 2019

The instrument hangs on a small set of technical concepts that connect clinical activity and administrative process to the PSR framework in the Act. Each concept is explicitly tied to a specific Act provision.

• Relevant service and relevant phone service (s 5). The instrument fixes which Medicare items count as "relevant" for the PSR. It does so in two ways: by specifying entire Groups and Subgroups of the general medical services table and by listing individual item numbers in tables embedded in s 5. For example, "relevant phone services" include items in specified Subgroups of Group A40 and Subgroup 3 of Group A45, plus listed individual items such as 92176, 92177, 93302, 93305, 93308, 93311, 93423 and 93453 (s 5). "Relevant services" covers a broader set of Groups (A1, A2, A5, A6, A7, A9, A11, A13, A14, A15, A17, A18, A19, A20, A21, A22, A23, A27, A35, A39, A41, A42, A43 or A45) and various Subgroups of Group A36 and Group A40, plus listed individual items such as 139, 90264, 90265, 92142, 92170, 92171, 92176 and 92177 (s 5). The instrument also notes that some services may be specified by determinations under subsection 3C(1) of the Act, so the precise scope depends on external material (s 5 Note).

• Adequate and contemporaneous records (s 6). For subsection 81(1) of the Act the instrument prescribes minimum elements: patient name; separate entry for each attendance; each entry must have the date, sufficient clinical information to explain the service, and be completed at the time of or as soon as practicable after the service; and the record must be comprehensible enough for another practitioner to undertake ongoing care in reliance on it (s 6(a)-(d)). The concept is therefore both content and timeliness based, and it links record quality to continuity of care.

• Exceptional circumstances (s 7). For subsection 82(1D) of the Act, the instrument identifies two concrete circumstances that will qualify as exceptional for a particular day for a practitioner: an unusual occurrence causing an unusual level of need for relevant services on that day; and the absence, on that day, of other medical services for the practitioner’s patients, assessed by reference to the practice location and patient characteristics (s 7(a)-(b)). These are narrow, situational defences when assessing whether day‑to‑day patterns of service are inappropriate.

• Prescribed pattern of services (s 8). Section 82A of the Act is given operational teeth by numeric tests in s 8: either (a) 80 or more relevant services on each of 20 or more days within a 12‑month period; or (b) 30 or more relevant phone services on each of 20 or more days in a 12‑month period (s 8(a)-(b)). These are per‑day volume triggers over repeated days in a rolling 12‑month window.

• Procedural allowances (s 9). For workability of PSR hearings, s 9 authorises attendance and travel allowances. Attendance allowances differ by witness type: actual fees for professional, scientific or other special skill witnesses; for other witnesses, reimbursement of lost salary/wages/fees up to $527 per day (s 9(3)-(4)). Travel allowances are a "reasonable amount" determined by the Professional Services Review Committee for transport and, if the witness must stay overnight, meals and accommodation (s 9(5)).

• Referral pathways (s 10-11). The instrument provides definitive referral lists for two circumstances under the Act: where PSR identifies a significant threat to life or health (paragraph 106XA(4)(a)) and where there may be non‑compliance with professional standards (subsection 106XB(3)). Section 10 lists specified persons and bodies separately for general practitioners and for non‑GP practitioners (s 10(2) and s 10(3)). Section 11 then clarifies that a body is "specified" for the purposes of non‑compliance only if it is on the s 10 list and has the power to take action against the practitioner, or if it has a function of assisting a person who is on the s 10 list and has that power (s 11(1)-(2)).

Across these concepts the instrument uses itemised Medicare schedules (Groups, Subgroups and item numbers) as the primary data source for drawing bright lines about what clinical activity will attract PSR attention. It also places administrative demands on practitioners via record standards and creates discrete, numerically defined triggers for higher scrutiny under the Act.

The Regulations affect several distinct actor groups within the PSR ecosystem. The instrument names them and prescribes specific obligations or procedural mechanics tied to each role.

• Practitioners and medical practitioners. The Regulations explicitly apply to "practitioner" and "medical practitioner" as those terms are used in Part VAA of the Act (s 5). They govern when a practitioner’s pattern of services can be treated as a "prescribed pattern" (s 8), and they establish the record standards that practitioners must meet for records of rendering or initiation of services (s 6). Practitioners who provide high daily volumes of items listed as "relevant services" or "relevant phone services" are the specific focus of s 8; meeting the numeric tests will cause the pattern to be prescribed for the purposes of s 82A of the Act.

• General practitioners. The Regulations create separate referral lists for general practitioners (s 10(2) and s 11(1)). The GPs’ referral list includes bodies such as the Australian College of Rural and Remote Medicine, Australian General Practice Accreditation Limited, the Australian Health Practitioner Regulation Agency, various state‑based complaint or medical councils and the Royal Australian College of General Practitioners (s 10(2)). Where a GP’s conduct raises a significant threat to life or health, PSR is directed to refer the matter to these named bodies (s 10(1)-(2)).

• Practitioners who are not general practitioners. A broader list of regulators and professional boards is specified for non‑GP practitioners (s 10(3)). The list includes many national boards (Pharmacy Board, Dental Board, Medical Board, Nursing and Midwifery Board, etc), some state bodies, the Department and the Human Services Department (s 10(3)(a)-(s)). For non‑GPs, those bodies will be the recipients of referrals where the PSR finds a significant threat to life or health.

• Professional Services Review Committees. The Committees themselves are addressed directly by the Regulations. The instrument prescribes how Committees determine and pay (or authorise) witness allowances and travel allowances for witnesses summoned to hearings (s 9). It also gives Committees a degree of discretion as to the reasonableness of travel allowances (s 9(5)).

• Witnesses summoned to PSR hearings. Witnesses with professional, scientific or other special skills are treated differently from ordinary witnesses. The instrument allows such experts to be reimbursed actual fees for preparation and attendance (s 9(3)); other witnesses can claim lost salary/wages/fees up to a daily cap of $527 (s 9(4)). Travel and overnight allowances are also possible, subject to Committee determination (s 9(5)).

• Regulatory and advisory bodies named as referral destinations. The instrument explicitly designates a set of national and state regulatory entities and professional colleges for referral purposes (s 10). Section 11 further constrains which of those bodies are "specified" for non‑compliance referrals by requiring they either have the power to take action against the practitioner or have functions assisting a body that does.

• Patients, indirectly. While the instrument speaks in terms of practitioners and bodies, it conditions record‑keeping and service definition around patient care: records must enable another practitioner to undertake ongoing patient care (s 6(d)), and "exceptional circumstances" for a day may be assessed having regard to patient characteristics (s 7(b)(ii)). Thus patient location and characteristics are factors that may affect the application of PSR provisions.

Notably absent from the instrument are explicit roles for payers, insurers or explicit payment obligations. The instrument ties itself to the Act and to the general medical services table; as a result, any party with interests in Medicare billing , clinics, billing services, practice managers and electronic health record vendors , will be affected indirectly because the instrument defines which Medicare items are scrutinised and what records must be held to justify claims.

The instrument also leaves certain definitions and scopes to external material. The lists of relevant items reference the general medical services table and determinations under subsection 3C(1) of the Act (s 5 Note). Therefore, changes to those external instruments or to the Act’s Part VAA definitions may change who is affected without amendment to this instrument.

This instrument does not create separate criminal offences or financial penalties. Instead it prescribes duties and procedural rights that interact with the Act’s enforcement mechanisms. The statutory duties and rights in the instrument are best read as inputs to the Act’s PSR process.

Duties on practitioners (express)

• Maintain records that meet the standard for "adequate and contemporaneous records" for every rendered or initiated service (s 6). The standard sets minimum content (patient name, separate entry per attendance, date, sufficient clinical information), timeliness (completed at the time, or as soon as practicable after, the service) and comprehensibility (s 6(a)-(d)). This is a duty to create and keep records in a way that supports continuity of care and later review.
• Be aware that patterns of service may be characterised as a "prescribed pattern" when volume thresholds are met: 80+ relevant services on each of 20+ days in a rolling 12 months, or 30+ relevant phone services on each of 20+ days in a 12‑month period (s 8). Practitioners providing high volumes of relevant or phone services therefore face the procedural consequence of triggering section 82A of the Act.

Duties on PSR Committees (procedural)

• Determine and provide allowances to witnesses according to the rules in s 9. The Committee must assess attendance allowances either by reimbursing actual fees for expert witnesses (s 9(3)) or reimbursing lost salary/wages/fees up to $527 per day for other witnesses (s 9(4)). Travel allowances must be determined as a reasonable amount by the Committee for transport and necessary overnight expenses (s 9(5)).

Rights and operational modalities

• Practitioners have the procedural right to have their record-keeping judged against the standards in s 6 if their records are queried under subsection 81(1) of the Act. How those standards are applied may affect the outcome of review processes under the Act.
• Witnesses have the right to be reimbursed under the instrument’s allowances if summoned by a Committee under subsection 106C(1) of the Act; the amount differs depending on whether the witness is an expert (actual fees) or an ordinary witness (lost earnings capped at $527 per day), and committees retain discretion to set reasonable travel amounts (s 9(2)-(5)).
• The PSR Committee has the right to refer matters to particular bodies if the committee forms the view a matter meets the Act’s referral grounds. Section 10 prescribes who may receive referrals where there is a significant threat to life or health, and s 11 prescribes which bodies are suitable recipients for non‑compliance with professional standards referrals, by reference to their powers to act.

Constraints and conditionalities

• The instrument conditions its definitions and duties on external instruments and the Act. For example, the meaning of practitioner and service is the same as in Part VAA of the Act (s 5), and the sets of relevant items are by reference to the general medical services table and possible determinations under subsection 3C(1) (s 5 Note). Consequently, duties in this instrument are contingent on material outside it.
• The instrument’s practical reach is limited by the Act’s enforcement architecture. For instance, s 6 supplies the standard only "for the purposes of the definition of adequate and contemporaneous records in subsection 81(1) of the Act." The instrument therefore defines content and timing standards that will be used as evidence or criteria in the PSR process rather than independently creating a disciplinary regime.

In short, the instrument creates concrete documentary duties on practitioners and procedural entitlements for witnesses and committees. The operational rights to referral and to reimbursement are delimited by the lists in s 10-11 and the monetary and discretional rules in s 9.

This instrument itself does not establish new penalties or enforcement powers. Instead it supplies prescribed matters that the Health Insurance Act 1973 uses to define when enforcement processes under that Act may be engaged and how certain procedural features of those processes will operate. The relevant enforcement architecture is therefore the Act; the Regulations sit beneath it as implementing detail.

How enforcement is engaged

• Triggering review and enforcement processes. The instrument sets thresholds and definitions that determine when investigatory or enforcement processes under the Act may be engaged. Section 8 prescribes the quantitative thresholds that, if met, mean a medical practitioner’s pattern of services is a "prescribed pattern" for the purposes of section 82A of the Act. The Act’s consequences that flow from a finding of inappropriate practice or prescribed pattern remain governed by the Act itself; the instrument provides the numerical test used in that evaluation.
• Record standards as evidentiary criteria. Section 6 prescribes the standard for "adequate and contemporaneous records" used in subsection 81(1) of the Act. The standard will be applied in PSR processes and therefore functions as the instrument’s principal mechanism for evidencing compliance or failure. Poor or non‑compliant records, assessed against the s 6 standard, can be relied on under the Act’s investigatory and disciplinary processes.

Practical enforcement mechanisms referenced

• Hearings and witnesses. The instrument addresses the mechanics of PSR hearings and witness attendance via s 9. The Committee’s ability to summon witnesses is in the Act (subsection 106C(1)); the instrument prescribes the allowances payable for such attendance (s 9). The availability of allowances is procedural and designed to enable hearings rather than to penalise.
• Referrals to regulatory bodies. Sections 10 and 11 specify where PSR should refer matters under particular heads in the Act: where there is a significant threat to life or health (paragraph 106XA(4)(a)) and where a practitioner may have failed to comply with professional standards (subsection 106XB(3)). The instrument therefore channels cases from PSR to bodies that may have disciplinary powers independent of the PSR,those bodies’ enforcement powers derive from their own governing legislation and functions, not from this instrument.

Limits of the instrument’s enforcement power

• No autonomous penalty clauses. The Regulations do not create fines, suspensions or other disciplinary sanctions directly; they merely supply definitions, standards and procedural allowances that will be applied under the Act. Any penalty or sanction arises from the Act or from actions taken by referral bodies with statutory powers.
• Discretion retained in the Act and by Committees. The instrument grants Committees discretion in certain matters, for example to determine a "reasonable amount" for travel allowances (s 9(5)) and to assess exceptional circumstances (s 7) by reference to particular factors. Enforcement outcomes therefore depend on both the Act’s discretionary provisions and the interpretation of these prescribed criteria in practice.

Practical enforcement consequences for practitioners

• If a practitioner meets the threshold in s 8, they are placed within the statutory concept of a "prescribed pattern" under the Act; that status will feed into investigatory or enforcement action as provided in the Act.
• Failure to meet the record standards in s 6 may affect the practitioner’s defence in any PSR proceeding under s 81 of the Act, by providing a statutory benchmark for records assessment.

In summary, the Regulations shape enforcement by supplying the Act with concrete, administrable criteria (records standards, numerical thresholds, referral lists and witness entitlement rules). The instrument does not itself punish; it sets rules that determine how, when and to whom the Act’s enforcement machinery can be applied.

The instrument is explicitly and exclusively made under the Health Insurance Act 1973; its interactions with other statutory instruments arise mostly by cross‑reference to provisions of that Act and to external instruments that define service items. The Regulations do not purport to override or to create separate regimes; they feed definitional and procedural detail into the Act’s PSR framework.

Primary statutory linkage

• Health Insurance Act 1973. The instrument is made under the Act (s 3) and repeatedly states that its sections are "for the purposes of" particular subsections of the Act. Examples include: s 6 (for the definition of adequate and contemporaneous records in subsection 81(1) of the Act); s 7 (for subsection 82(1D) of the Act); s 8 (for section 82A of the Act); s 9 (for subsection 106C(1) of the Act); s 10 (for paragraph 106XA(4)(a) of the Act); and s 11 (for subsection 106XB(3) of the Act). The Regulations therefore act as subordinate instruments that fill gaps or prescribe particulars that the principal Act requires to be prescribed.

Interaction with the general medical services table and determinations

• The definitions of "relevant service" and "relevant phone service" (s 5) are made by reference to the general medical services table (Groups, Subgroups and item numbers) and to items that may be set out in determinations under subsection 3C(1) of the Act. The instrument therefore interacts with and depends on:
  • The content of the general medical services table, which the instrument uses to specify which items will be treated as relevant for PSR purposes.
  • Any determinations made under subsection 3C(1) of the Act that specify additional items. Because the instrument points to external lists and determinations, changes to those external instruments will change the scope of what counts as relevant without amendment to the Regulations themselves.

Cross‑agency and regulator interactions

• The instrument expressly lists national boards, professional colleges and state complaint bodies as referral recipients (s 10 and s 11). When PSR refers matters to those bodies under the Act’s referral powers, the business of regulation will cross‑fertilise between PSR and those bodies. Section 11 constrains which of those bodies are "specified" in relation to non‑compliance by requiring either power to take action against practitioners or the function of assisting a body that has that power (s 11(1)-(2)). Thus, the instrument creates formal referral lines from PSR into existing professional regulation frameworks.

Ambiguities in cross‑reference

• Undefined or externally defined terms. The instrument uses expressions defined "in the Act" and in Part VAA (s 5). It also refers to "the Department" in s 10(3)(f) without defining that term within the instrument. The reader must therefore consult the Act and other administrative instruments to understand fully the interactional map. The instrument does not itself settle such definitional matters.

Limits on conflict

• The instrument does not purport to displace other statutory regulation of health practitioners or to modify the powers of regulatory boards; it merely identifies referral routes and supplies procedural standards for use by PSR under the Act. Enforcement powers remain with the Act and with any referral bodies as authorised in their own legislation.

Operational effect

• Because Medicare item numbers and the general medical services table are central to Commonwealth health funding, linking the PSR scrutiny to specific Groups, Subgroups and item numbers effectively ties PSR’s reach into the Medicare billing system. Any changes to the Medicare schedule (general medical services table) or to the Act’s determinations therefore alter how PSR reviews will operate in practice.

In short, the instrument interacts with the Health Insurance Act 1973 as its primary legal host, and with the Medicare item schedule and with external regulatory bodies via referral lines. The Regulations are not free‑standing; their legal effects depend on the Act and on external, referenced material.

The instrument itself is short on historical amendments within the supplied text, but it includes one explicit transitional provision recording the effect of a later amending instrument.

• Original instrument and authority. The instrument is the Health Insurance (Professional Services Review Scheme) Regulations 2019 and is made under the Health Insurance Act 1973 (s 1, s 3). The supplied text does not include the 2019 instrument’s date of assent or commencement beyond the instrument name.

• Amendment recorded in the text. Section 12 records an amendment made by the Health Insurance (Professional Services Review Scheme) Amendment (2022 Measures No. 4) Regulations 2022. That amendment is described in transitional terms: "Paragraph 8(b) applies in relation to relevant phone services rendered on or after 1 October 2022" (s 12). Paragraph 8(b) is the provision in s 8 that prescribes the 30‑services‑per‑day threshold for relevant phone services as a test for a prescribed pattern under section 82A of the Act. Consequently, the instrument explicitly discloses that the phone‑service threshold in s 8(b) was given retrospective or prospective application from 1 October 2022 by the 2022 amending instrument.

• No other amendment history supplied. The supplied text does not list any other amendments, revocations or historical notes. It does not include commencement dates for the bulk of the instrument other than the transitional note in s 12. Any additional amendments, revocations or historical notes will have to be checked in the consolidated legislative database or in the amending instrument itself; that material is not included in the text provided here.

• Dependence on external determinations. The instrument’s effective content can be altered indirectly without formal amendment by changes to the general medical services table and by determinations under subsection 3C(1) of the Act (s 5 Note). Such external changes will change which item numbers are captured as relevant services or relevant phone services, and thus alter how the numerical thresholds in s 8 operate in practice. That effect is not recorded here as an "amendment" to the instrument, but it is a practical pathway by which the instrument’s operational scope changes over time.

To trace the instrument’s full amendment history or to confirm the commencement dates of specific provisions, a user must consult the amending instruments and the Act’s consolidated text. The only explicit amendment recorded in the supplied text is the 2022 Measures No. 4 transitional provision affecting the phone‑service threshold from 1 October 2022 (s 12).

The supplied instrument text contains no references to judicial or tribunal decisions, and it does not cite any litigation or judicial interpretation. There are no case names, reported judgments, or extracts from judicial decisions included in the material provided.

Because the Regulations provide definitional and procedural detail for use under the Act, litigation or administrative review may have occurred in relation to the Act’s PSR provisions more generally; however, the instrument as supplied does not record any litigation history, nor does it summarise how courts or tribunals have construed the specific provisions (for example s 6, s 7, s 8 or s 9). Any relevant judicial or administrative decisions that interpret these Regulations, or that apply them in practice, are therefore outside the scope of the provided text and must be identified by consulting case law databases or the consolidated Act’s annotations.

For present purposes the instrument should be treated as a statutory statement of definitions, thresholds and procedural rules without separately supplied adjudicative history. Users seeking precedential treatment, interpretation or the application of these provisions in contested proceedings must locate and analyse decisions that cite the Health Insurance (Professional Services Review Scheme) Regulations 2019 and the related provisions of the Health Insurance Act 1973.

The instrument contains several technical features and delegated dependencies that can produce traps for practitioners, committees and advisers. These "gotchas" stem from dependence on external materials, discretion left to committees, subjective standards, and fixed numeric thresholds.

1. Dependence on the general medical services table and determinations (s 5 Note)

• The lists of "relevant services" and "relevant phone services" are specified by reference to Groups, Subgroups and item numbers in the general medical services table and by reference to determinations under subsection 3C(1) of the Act. The instrument therefore does not permanently fix those item numbers in isolation. If the general medical services table or relevant determinations are changed, the scope of what is "relevant" for PSR changes without amending these Regulations. Practitioners must therefore monitor both the Regulations and the schedule/determinations they reference.

2. Numeric thresholds are rigid by formula but sensitive to counting methodology (s 8)

• The prescribed pattern tests require meeting a per‑day count on at least 20 days in a 12‑month period: 80+ relevant services or 30+ relevant phone services. The instrument does not specify the precise counting methodology (for example, whether multiple item numbers on a single claim or multiple services to the same patient on the same day are aggregated in a specific way, or whether the clock is a rolling 12‑month window). That procedural detail is likely governed by the Act or administrative practice, but absent specific counting rules here, different counting assumptions could materially change whether a practitioner hits the threshold.

3. Subjectivity in "sufficient clinical information" and "as soon as practicable" (s 6(c)(ii)-(iii))

• The record standard requires "sufficient clinical information to explain the service" and that entries be "completed at the time, or as soon as practicable after" the service. Both "sufficient" and "as soon as practicable" are context dependent and will be assessed by PSR or by referral bodies. Practitioners operating high throughput clinics may struggle to establish a consistent compliance standard unless their record templates force specific minimum fields.

4. The "another practitioner" test for comprehensibility (s 6(d))

• Records must be comprehensible enough to enable another practitioner to effectively undertake ongoing care in reliance on them. This imports a continuity‑of‑care benchmark that could be stricter than minimal audit trails for billing compliance. Practices using shorthand, templates without clinical detail, or outsourced transcription need to ensure the result meets this substantive standard.

5. Exceptional circumstances are narrow and fact‑specific (s 7)

• The instrument limits "exceptional circumstances" to two specific kinds of situations for a particular day. The presence of an unusual occurrence causing unusual need or absence of other medical services must be demonstrated with regard to practice location and patient characteristics (s 7). Using the exceptional circumstances defence casually in the face of persistent high volumes is unlikely to satisfy PSR.

6. Travel allowance discretion and the attendance cap (s 9)

• For ordinary witnesses the daily cap for lost earnings is $527 (s 9(4)). The text does not provide for indexation. Expert witnesses can recover "actual fees" (s 9(3)), but there is no guidance here on limits, prior approval or whether such fees must be reasonable. Travel allowances are a "reasonable amount" determined by the Committee (s 9(5)), giving Committees wide latitude but also creating uncertainty for potential witnesses who must budget for travel or lodging.

7. Ambiguity in "the Department" for non‑GP referral list (s 10(3)(f))

• Section 10(3)(f) lists "the Department" among recipients for non‑GP referrals. The instrument does not define which department is meant within its own text. The absence of a definition in the supplied instrument means advisers must consult the Act or external materials to determine which agency is intended.

8. Referral lists and the power requirement under s 11

• A body is specified for non‑compliance referrals only if it is on the s 10 list and has power to take action against the practitioner or has a function assisting such a body (s 11(1)-(2)). A naive reading of the s 10 list without this qualification could lead to inappropriate referrals to bodies that are listed but cannot act in the specific case. PSR Committees must therefore check that the recipient body has the requisite power before making a referral under subsection 106XB(3) of the Act.

9. Transitional timing for phone‑service threshold (s 12)

• The phone‑services test in s 8(b) is explicitly made to apply to relevant phone services rendered on or after 1 October 2022 by s 12. If practitioners provided many phone services before that date but not after, those earlier services may not count for the s 8(b) trigger. Conversely, behaviour patterns after that date are captured. Practitioners should be conscious of the temporal application.

10. External enforcement uncertainty

• Because the instrument relies on the Act and on external bodies for enforcement, outcomes depend on how the Act’s delegated powers are exercised by Committees and how referral bodies exercise their regulatory powers. The instrument itself gives little guidance on procedural timelines, evidentiary thresholds beyond records standards, or internal appeal paths for decisions that follow from these prescribed matters.

In sum, the principal risks for practitioners and advisers are (a) failing to track changes to the referenced Medicare tables and determinations, (b) insufficient detail in records to meet the s 6 standard, (c) unexpectedly triggering the numerical thresholds in s 8 because of counting ambiguities, and (d) uncertainty about the identity and powers of referral bodies for non‑GPs due to the use of the undefined term "the Department."

This section sets out practical steps that practitioners, practice managers, PSR Committees, and advisers should take to align with the instrument’s requirements as drafted.

Records and documentation (comply with s 6)

• Implement record templates that enforce the s 6 minimums. Each patient encounter should have a discrete record entry that contains:
  • The patient’s full name (s 6(a));
  • A separate entry for each attendance (s 6(b));
  • The date the service was rendered or initiated (s 6(c)(i));
  • Sufficient clinical information to explain the service (s 6(c)(ii)) , a concise clinical summary of reason for service, clinical findings, diagnosis or working diagnosis and the clinical basis for the specific service billed; and
  • Timestamping or workflow rules that record when the entry was completed and ensure entries are completed at the time or as soon as practicable after the service (s 6(c)(iii)).
• Ensure records are comprehensible to another practitioner (s 6(d)). That means avoiding unexplained acronyms or shorthand, including relevant observations and follow‑up instructions, and storing documentation in a retrievable, readable format (paper or electronic).
• Audit record‑keeping. Run periodic internal audits against the s 6 checklist to catch systemic shortfalls before they are examined under the Act.

Monitor service volumes and item use (comply with s 8 and s 5)

• Map which Medicare items your practice bills to the instrument’s lists of "relevant services" and "relevant phone services" (s 5). The instrument references Groups and Subgroups and lists specific item numbers; practices should extract those item numbers (for example item numbers 92176, 92177, 93302, 93305, 93308, 93311, 93423, 93453 and others listed in s 5) and tag them in internal billing systems.
• Track daily service counts per practitioner. To avoid unintentionally meeting the s 8 thresholds, implement reporting that counts the number of "relevant services" and "relevant phone services" per practitioner per day over rolling 12‑month windows.
• Prepare for the counting methodology. Because the instrument does not set out detailed counting rules (for example aggregation methods), develop and document a consistent internal counting method and, if necessary, seek clarification from PSR or the Department about the counting approach used in enforcement.

Document exceptional circumstances (use s 7)

• When a day’s activity spikes because of an unusual occurrence or because other services were absent, contemporaneously document the reason and the contextual factors that relate to the practice location and patient characteristics as required in s 7(b)(i)-(ii). Photographs, incident reports and contemporaneous logs will assist in establishing the exceptional circumstances defence under subsection 82(1D) of the Act.

Witness and hearing preparedness (s 9)

• If the practice or practitioner is likely to be involved in a PSR hearing as a party or a witness, plan for witness availability and likely compensation. Expert witnesses can claim actual fees for preparation and attendance (s 9(3)); ordinary witnesses can claim lost earnings up to $527 per day (s 9(4)). Confirm with the Committee any expectations regarding prior authorisation of fees and the scope of "reasonable" travel expenses (s 9(5)).
• Keep accurate records of time lost from salary or fees to substantiate any attendance allowance claims under s 9(4).

Referral and regulatory engagement (s 10-11)

• Know the referral list applicable to your role. General practitioners should be familiar with the bodies listed in s 10(2); non‑GP practitioners should be familiar with the broader list in s 10(3). If PSR refers matters, the receiving body will be one of these listed bodies, and s 11 requires that body to either have power to act or to assist a body that does.
• If referred, seek early contact with the recipient body to understand its investigatory powers and timelines. The Regulations identify who may receive a referral but do not describe how the recipient body will proceed.

Maintain awareness of external instruments

• Because the definition of relevant items refers to the general medical services table and determinations under subsection 3C(1) of the Act (s 5 Note), practices must monitor changes to those documents. Any change in the schedule or a determinative instrument can expand or contract what counts as "relevant" for s 8 and related PSR activity.

Governance and systems

• Update practice policies to mandate adherence to the s 6 record standard and to require contemporaneous documentation of exceptional circumstances.
• Train clinicians and administrative staff on the s 6 content and timing expectations, on the items that count as relevant services, and on the internal counting and reporting of service volumes.
• If using third‑party billing or electronic health record vendors, confirm that item coding and record templates capture the information required by s 6 and that billing categorisation aligns with the item lists in s 5.

Legal and compliance review

• Periodically review the practice’s compliance posture with lawyers or compliance specialists familiar with the Act and with PSR processes, focusing on record quality and on mitigation of exposure to the s 8 triggers.
• If queried under the Act, ensure documentation of how internal counting is done and provide contemporaneous records meeting the s 6 standards as the primary statutory defence.

Transitional awareness (s 12)

• Be aware that the phone‑service threshold in s 8(b) applies to relevant phone services rendered on or after 1 October 2022 (s 12). If your practice’s high phone‑service volumes were concentrated before that date, they will not count towards the s 8(b) threshold; volumes on or after that date will.

Following these steps will align operational practice with the instrument’s prescribed standards and thresholds. The central compliance levers are robust, contemporaneous clinical records (s 6), careful monitoring of itemised service volumes against the listed item numbers and Groups (s 5 and s 8), and contemporaneous documentation of any exceptional circumstances (s 7).