The 80/20 Rule – What You Need to Know

There is a common misconception that the ‘80’ in the 80/20 rule refers to the number of patients seen by a practitioner in a day, which is not the case.

The Department of Health (the Department) considers a GP or OMP (Other Medical Practitioner) 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.

The Department actively monitors practitioners who are close to breaching the 80/20 rule, and may contact practitioners to remind them of their obligations under the Health Insurance Act 1973.

If a practitioner breaches the 80/20 rule, either as a standalone concern or in conjunction with other allegations of inappropriate practice, he or she will be referred to the Practitioner Review Program.

Please don’t ignore any correspondence you receive from the Department relating to concerns about your billing. If in doubt, contact your MDO for further advice and guidance.

This blog contains general information only. We recommend you contact your medical defence organisation or insurer when you require specific advice in relation to medico-legal matters.