Predicted versus Actual Utilisation Monitoring Process

Page last updated: 29 September 2017

The Department reports to MSAC on the utilisation of MBS items. To ensure that new items or item amendments are being used as intended, a predicted vs actual (PvA) utilisation monitoring process has been established for services MSAC has supported and the Department of Health has subsequently listed on the Medicare Benefits Schedule (MBS). This process is not intended to be a review of the clinical information provided during the application process. The PvA utilisation monitoring process assesses the real-world impacts of MSAC-supported applications by comparing projections of claims with actual service volume patterns 24 months after listing.

MSAC can make recommendations in relation to:

  • referring inappropriate co-claiming of services to the Department compliance area;
  • the MBS item descriptor and fee for the service requiring amendment;
  • identifying issues with access to services;
  • other matters related to the public funding of health services.
After a service reviewed under the PvA utilisation monitoring process has been considered by MSAC, a Public Summary Document is prepared and made available on the MSAC webpage.

Applications reviewed at the November 2016 MSAC meeting are: