GPCCMP FAQ - Compliance & Quality Assurance
Categories:
Understanding GPCCMP & Key Changes – Overview of the GP Chronic Care Management Program and what’s new under GPCCMP.
Transitioning Existing Patients & Plans – How to move existing care plan patients smoothly into GPCCMP.
Staff Roles & Responsibilities – Clarifies who does what in GPCCMP workflows, from GPs to nurses and admin staff.
Specific Patient Groups & Edge Cases – Advice for managing complex patients and uncommon GPCCMP scenarios.
Practice Management & Clinical Software – Guides for using clinical software and Cubiko tools to support GPCCMP workflows.
Patient Communication & Operational Planning – Templates and tips for engaging patients and planning care delivery efficiently.
MyMedicare Requirements – What practices and patients need to know about MyMedicare registration and eligibility.
MBS Item Numbers & Billing – Understand which MBS items apply, how to claim correctly and avoid common billing errors.
GPCCMP Plan Creation & Reviews – Step-by-step guidance for creating, reviewing and updating GP Chronic Care Management Plans.
Financial Strategy & Practice Efficiency – Practical tips to improve billing accuracy, profitability and workflow efficiency.
Allied Health Referrals Under GPCCMP – How to manage allied health referrals linked to GP Chronic Care Management Plans.
What are the compliance requirements and documentation standards for GPCCMP?
The Bottom Line:
The good news is that GPCCMP documentation requirements are clearly defined and much more streamlined than the old system. The requirements include specific plan components, proper consent procedures, and record-keeping standards.
The Facts:
-
Preparing a GPCCMP is defined as preparing a written plan that describes:
-
The patient's chronic condition(s) and associated healthcare needs
-
Health and lifestyle goals developed by the patient and medical practitioner using a shared decision-making approach
-
Actions to be taken by the patient
-
Treatment and services the patient is likely to need
-
If multidisciplinary care is beneficial, the services to which the patient will be referred (including their purposes)
-
Arrangements to review the plan, including the proposed timeframe for review
-
The process of developing and finalising a GPCCMP must include:
-
Recording the patient's consent and agreement to the plan preparation
-
Offering a copy of the plan to the patient and their carer (if any, and if appropriate and agreed)
-
Adding a copy of the plan to the patient's medical records
-
If referring to a multidisciplinary team, the GP or PMP must:
-
Obtain the patient's consent to sharing relevant information, including relevant parts of the plan, with the multidisciplinary team
-
If the patient consents, provide relevant parts of the plan to the members of the multidisciplinary team, in addition to the referral
-
Practice nurses, Aboriginal and Torres Strait Islander Health Practitioners and Aboriginal Health Workers may assist with the development or review of a GPCCMP, though the GP or PMP retains responsibility for the service and must see the patient as part of the service
-
GPs and PMPs are encouraged to upload the GPCCMP to My Health Record if the patient consents
-
Providers must keep adequate and contemporaneous records, and where an MBS item specifies the creation of a document, that document must be retained for 2 years
Sources: Upcoming Changes to Chronic Disease Management Framework – MBS Items for GP Chronic Condition Management Plans – Factsheet, pages 3-4; MBS Online explanatory note AN.0.47; MBS Online explanatory note AN.0.47, AN.15.3
Links and Resources:
Implementation Support:
Official Documentation:
Services Australia Provider Enquiry Line: 13 21 50
Will Medicare review our GPCCMPs, and how often will these reviews occur for quality and compliance purposes?
The Bottom Line:
Yes, Medicare services including GPCCMPs are subject to ongoing compliance checks, and providers may be asked to submit evidence of services billed. Additionally, the GPCCMP framework itself will be subject to post-implementation review around two years after introduction. Providers are responsible for ensuring services meet all legislative requirements and keeping adequate records.
The Facts:
-
Changes to MBS items are subject to post-implementation review, which typically occurs around 2 years after implementation of the change
-
Providers are responsible for ensuring Medicare services claimed using their provider number meet all legislative requirements
-
All Medicare claiming is subject to compliance checks, and providers may be required to submit evidence about the services they bill
-
Providers should ensure they keep adequate and contemporaneous records for all GPCCMP services
-
Providers seeking advice on interpretation of MBS items, explanatory notes and associated legislation can use the Department of Health, Disability and Ageing's email advice service by emailing askMBS@health.gov.au
-
Practices can subscribe to future MBS updates by visiting 'Subscribe to the MBS' on the MBS Online website, and to 'News for Health Professionals' on the Services Australia website to receive regular news highlights
Sources: Upcoming Changes to Chronic Disease Management Framework – MBS Items for GP Chronic Condition Management Plans – Factsheet, page 6; Upcoming Changes to Chronic Disease Management Framework – Overview – Factsheet, page 4; MBS Online explanatory note AN.0.47
Links and Resources:
Compliance Information:
Medicare Compliance Information: Available on Department of Health, Disability and Ageing website
Quality Assurance:
Official Resources:
Services Australia Provider Enquiry Line: 13 21 50
Has Medicare released guidance on fixing minor billing errors with GPCCMP items?
The Bottom Line:
There is no specific guidance on fixing minor billing errors for GPCCMP. For current billing issues, the recommended approach is direct contact with Services Australia.
The Facts:
-
Providers are responsible for ensuring Medicare services claimed using their provider number meet all legislative requirements
-
All Medicare claiming is subject to compliance checks, and providers may be required to submit evidence about the services they bill
-
Future Practice Management System updates will introduce co-claiming validation to assist with billing accuracy when claiming the new GPCCMP items, which is designed to reduce billing errors and support compliance
Sources: Preparing for Chronic Condition Management Changes in Bp Premier, pages 5, 7; Upcoming Changes to Chronic Disease Management Framework – MBS Items for GP Chronic Condition Management Plans – Factsheet, page 6; MBS Online explanatory note AN.0.47; MBS Online explanatory note AN.0.47
Links and Resources:
Billing Support:
Services Australia Provider Enquiry Line: 13 21 50
Practice Management:
How long does Medicare take to correct billing mistakes under GPCCMP?
The Bottom Line:
The MBS factsheets don't cover specific timeframes for billing corrections - that's operational detail that Services Australia handles directly. For timing queries, contacting their Provider Enquiry Line is the recommended approach.
The Facts:
The MBS factsheets don't provide specific information on this topic. Services Australia handles operational billing corrections and can provide current timeframes for specific situations.
Links and Resources:
Billing Support:
Services Australia Provider Enquiry Line: 13 21 50
Practice Management:
How do we keep care quality high and track which patients need GPCCMP attention to prevent them falling through the cracks?
The Bottom Line:
The new GPCCMP framework emphasises regular reviews and streamlined processes to support high-quality care. Tools like Cubiko's can help identify eligible patients and forecast billings.
The Facts:
-
A key objective of the changes to the arrangements for chronic condition management is to encourage regular reviews of GPCCMPs
-
Patients will need to have their GPCCMP prepared or reviewed in the previous 18 months to continue to access allied health services
-
Unless exceptional circumstances apply, items for preparing a GPCCMP can be claimed every 12 months if clinically relevant; GPCCMP reviews are available every 3 months if clinically relevant
-
Reviewing a GPCCMP means the GP or PMP must discuss and document patient progress in relation to goals, and whether any updates should be made, taking into account information from multidisciplinary teams
-
The process of reviewing a GPCCMP must include recording patient consent, offering a copy of the updated plan to the patient, and adding it to the patient's medical records
-
Practice nurses, Aboriginal and Torres Strait Islander Health Practitioners and Aboriginal Health Workers may assist with the review process, working alongside practitioners to prepare and document GPCCMP appointments
-
You'll find that Cubiko's Quality Improvement Measures and PDSA cycle make it easy to track progress.
-
Regular auditing of patient records is recommended to identify those due for GPCCMPs, reviews, investigations, immunisations or screenings to support proactive care delivery and prevent patients from being missed
Sources: RACGP Summary of changes to Chronic Disease Management (CDM) Framework, page 2; Upcoming Changes to Chronic Disease Management Framework – MBS Items for GP Chronic Condition Management Plans – Factsheet, pages 2, 4, 5; MBS Online explanatory note MN.12.4
Links and Resources:
Quality Management Tools:
Patient Tracking & Audit Tools:
Cubiko Quality Improvement Measures & PDSA Cycle: Track 10997 billings and set targets for continuous improvement
Planning Resources:
What are the specific penalties for non-compliance with GPCCMP requirements?
The Bottom Line:
The MBS factsheets consistently emphasise that compliance checks are standard practice and providers are responsible for ensuring services meet legislative requirements. While they don't specify particular penalties, they do note that providers may need to submit evidence about billed services. Providers must keep adequate records, with documents requiring retention for 2 years where MBS items specify document creation.
The Facts:
-
Providers are responsible for ensuring Medicare services claimed using their provider number meet all legislative requirements
-
All Medicare claiming is subject to compliance checks, and providers may be required to submit evidence about the services they bill
-
Providers must ensure they keep adequate and contemporaneous records, with documents requiring retention for 2 years where MBS items specify document creation
-
More information about the Department of Health, Disability and Ageing's compliance program can be found on its website at Medicare compliance
Sources: Upcoming Changes to Chronic Disease Management Framework – MBS Items for GP Chronic Condition Management Plans – Factsheet, page 6; Upcoming Changes to Chronic Disease Management Framework – Overview – Factsheet, page 4; MBS Online explanatory note AN.0.47; MBS Online explanatory note AN.0.47
Links and Resources:
Compliance Information:
Medicare Compliance Information: Available on Department of Health, Disability and Ageing website
Services Australia Provider Enquiry Line: 13 21 50
Risk Management:
Official Information:
Department MBS Email Advice Service: askMBS@health.gov.au
Subscribe to MBS Updates: Available on MBS Online website
Services Australia News for Health Professionals: Subscribe on Services Australia website
Services Australia Provider Enquiry Line: 13 21 50
Disclaimer: This FAQ is for general information only and reflects our understanding of upcoming changes to chronic disease management frameworks at the time of publication. For the most accurate and up-to-date guidance, please refer to official sources such as the Department of Health and Aged Care or Medicare. Cubiko is not responsible for any actions taken based on this information.