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A Guide To Regulatory Compliance in Healthcare

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Just about every field and industry in Australia is governed by certain rules and regulations to maintain safety, efficiency, professionalism and may also have its own particular programs, certificates, and so forth.

The same applies to the medical profession and in this article, we’re going to be providing a brief guide on regulatory compliance in the healthcare industry.

Why Compliance In Healthcare Is Important

When it comes to regulatory compliance healthcare comes under even greater scrutiny, due to the fact that the health and safety of patients is always an ongoing concern. It’s vital that any industry is governed to ensure compliance and safety, but this is even more important for healthcare professions.

Regulations within the healthcare industry are not just focused on health and safety alone though, as there are other things to take into consideration, such as PESCI, Health Workforce Certificates, Pharmaceutical Manufacturers, Medicare, and AHPRA.

What Is AHPRA?

AHPRA represents the Australian Health Practitioner Regulation Agency. This agency is a national agency that’s tasked with implementing the National Registration and Accreditation Scheme across the entire country. The agency actually works with a total of 15 national boards with the aim to protect the health of the public by regulating all healthcare practitioners in Australia. It’s all about setting standards that have to be met to ensure professionalism and safety. Alternatively, AHPRA is also there to assist and protect people working in the medical profession.

Under national law, students who are studying an approved course or profession will need to apply for an AHPRA certification. Students themselves don’t have to be responsible for the application, as the education facility can apply on their behalf.

Some of the professions AHPRA cover include:

  • Medical
  • Chiropractic
  • Dental
  • Chinese medicine
  • Nursing
  • Midwifery
  • Occupational therapy
  • Health practice for Aboriginal and Torres Strait Islanders
  • Pharmacy
  • Physiotherapy
  • And many more…

Applying for a Medicare Provider Number

If you’re working in an area of healthcare where Medicare is relevant, such as a general practitioner, in order to facilitate Medicare or to bulk-bill, you will first need to apply for a Medicare Provider Number or Prescriber Number.

Before an individual or entity can apply for a Medicare Provider Number, you must first have an NPI number. This number is a 10 digit number for a healthcare entity and is known as a National Provider Number. The purpose of the NPI is for it to be shared with health plans, employers, other providers, as well as payers for the purpose of billing.

Once you have an NPI number, you can apply for a Medicare Provider Number by completing the Medicare Enrollment Application.

Now that you’ve applied for a Medicare Provider Number, you will be working with a MAC (Medicare Administrative Contact). Your MAC will be in the specific region or location of your application and practice. They will process your application and may even request additional information to ensure a successful outcome. You can also check the progress and result of your application with your MAC.

Navigating the Pre-Employment Structural Clinical Interview (PESCI)

If you’re planning on entering a career in general practice, you will first need to successfully complete a PESCI. This is a prerequisite for gaining registration in your state or territory and is governed by AHPRA. The registration committee of the Medical Board of Australia will handle the PESCI in each state or territory, while the RACGP can handle PECSI in New South Wales, Tasmania, and South Australia.

The reason candidates must undergo a PESCI is to ensure they have the knowledge, experience, and ability for safe practice in their proposed medical profession. During a Pre-Employment Structural Clinical Interview, each candidate is individually assessed to ascertain that they meet the requirements. During this assessment, a candidate’s suitability for a particular position will also be assessed.

One prerequisite before undergoing a PESCI examination will be verifiable proof of having attained a medical qualification.

In Conclusion

Attaining medical certificates, applying for things like a Medicare Provider Number, successfully passing a PESCI examination, and complying with the rules and regulations of AHPRA can all be a bit of a mind field. There are organisations and departments out there that can help you every step of the way, so there’s no need to try and comprehend it all and navigate everything on your own.

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