[Guides](/guides) Medicare billing compliance: claim time limits, records and the 80/20 rule ========================================================================== Updated 28 October 2026 Medicare compliance comes down to a handful of rules: claim within **one year** of the service, keep **adequate and contemporaneous** records that support every item you bill, keep the documents an item requires for **2 years**, and avoid a **prescribed pattern of services**: 80 or more services on 20 or more days in a year, or 30 or more phone services on 20 or more days. Claim within one year --------------------- For services on or after **5 September 2025**, a Medicare claim must be lodged within **one year** of the date of service. The limit was two years, and still is for earlier services and for benefits assigned to insurers under simplified billing. Services Australia accepts late lodgement only in limited circumstances. There is no MBS “30-day rule” for lodging claims. Keep adequate, contemporaneous records -------------------------------------- Under the Professional Services Review scheme, a record is **adequate** if it: - clearly identifies the patient; - has a separate entry for each attendance, with the date; - contains enough clinical information to explain the service you billed; - is clear enough that another practitioner could take over the patient’s care. It is **contemporaneous** if it is completed at the time of the service, or as soon as practicable afterwards. If the record doesn’t support the item, for example its time requirement or required content, the benefit may have to be repaid. How long to keep documents -------------------------- - Documents an item requires, such as care plans and referrals, for **2 years**. - Assignment of benefit agreements for bulk billing, for **2 years** from the date of the claim. See [assignment of benefit changes](/guides/assignment-of-benefit-2026). - Clinical records generally: state and territory health records laws set longer periods. Services Australia can ask you to produce documents for services in the previous 2 years. The 80/20 and 30/20 rules ------------------------- You engage in a **prescribed pattern of services** if, in a 12-month period, you render or initiate: - **80 or more services on each of 20 or more days** (the 80/20 rule), or - **30 or more phone services on each of 20 or more days** (the 30/20 rule). The days don’t need to be consecutive. Reaching either threshold leads to referral to the Director of Professional Services Review unless exceptional circumstances applied, such as an unusual situation or the absence of other practitioners. Bill what you did ----------------- - Choose the item whose descriptor matches what you did, including any time, setting and content requirements. - Don’t claim items that the descriptors say can’t be claimed together. - When bulk billing, accept the benefit as full payment, with no extra charges for that service. - Get informed financial consent before charging a gap: the Medical Board’s code of conduct expects patients to know your fees in time to decide whether to proceed. See [in-hospital billing](/guides/in-hospital-billing-and-gap-cover). Frequently asked questions -------------------------- ### How long do I have to lodge a Medicare claim? For services on or after 5 September 2025, one year from the date of service. Earlier services had two years. ### Is there a 30-day rule for Medicare claims? No. There is no MBS rule requiring claims within 30 days. The time limit for lodging a claim is one year from the date of service, and the 30/20 rule is about phone services, not claiming time. ### What is the 80/20 rule? Rendering or initiating 80 or more Medicare services on each of 20 or more days in a 12-month period. It is a prescribed pattern of services and leads to referral to the Professional Services Review unless exceptional circumstances applied. ### What is the 30/20 rule? Rendering or initiating 30 or more phone services on each of 20 or more days in a 12-month period. Like the 80/20 rule, it is a prescribed pattern of services. ### What makes a medical record adequate for Medicare? It identifies the patient, has a dated entry for each attendance, includes enough clinical information to explain the service billed, and is clear enough for another practitioner to continue the patient’s care. It should be completed at the time of the service or as soon as practicable afterwards. ### How long must I keep referrals and care plans? For 2 years, for documents that an MBS item requires. State and territory laws require clinical records in general to be kept for longer. More guides ----------- - [How Medicare benefits work: schedule fees, 75%, 85% and 100%](/guides/how-medicare-benefits-work) - [Medicare safety nets explained: original and extended (EMSN) thresholds for 2026](/guides/medicare-safety-nets) - [In-hospital billing: the 75% benefit, the 25% fund benefit, and no-gap and known-gap schemes](/guides/in-hospital-billing-and-gap-cover) - [Bulk billing incentives and BBPIP explained: 2026 amounts by MM area](/guides/bulk-billing-incentives) - [The MBS multiple operation rule and surgical assistant fees](/guides/multiple-operation-rule) - [Assignment of benefit for bulk billing: the changes from 1 July 2026](/guides/assignment-of-benefit-2026) - [MBS telehealth rules: the eligible telehealth practitioner and phone items](/guides/mbs-telehealth-rules) - [GP chronic condition management plans: items 965 and 967 explained](/guides/chronic-condition-management-plans) General information for health professionals, not legal or financial advice. Check MBS Online and Services Australia for the rules that apply to your circumstances.