Medicare 80/20 rule

80/20 rule is a rule that says that a Doctor cannot see 80 patients or more per day for 20 days in any 12 months period.

Example. Today is 29th May 2020. You have had 20 random days in the period from 29th May 2019 when you service 80 patients or more. This is an absolute offence.

More information on how Medicare counts the services is here.

There is no defence to this offence. GP will be fined for breaching 80/20 rule no matter what.

Rumours are circulating about GPs being flagged for seeing 60+ patients a day for 15 days in any 12 months period. This was dubbed as ’60/15 rule’.

‘Flagging’ by Medicare may lead to an audit for other reasons. For example, pathology and radiology referrals etc.

Tag: 80/20