Fees and payments in the workers compensation system

As of Friday 1 June 2018, icare will implement a new maximum fees list for diagnostic imaging services provided to workers compensation patients covered by icare.To be reimbursed for services provided, you'll need to submit an invoice to the insurer within 30 days of providing the service.

The relevant MBS code/s should be included on all invoices for diagnostic imaging services.In addition, all practices providing diagnostic imaging services to workers compensation patients covered by icare will need to meet accreditation standards in accordance with Diagnostic Imaging Accreditation Scheme (DIAS) requirements.Practices must meet DIAS entry-level accreditation standards by 1 October 2018.

DIAS full suite accreditation standards must be met by 1 October 2020. Details on requirements for DIAS accreditation is available on the Australian Government Department of Health website. Introduction of accreditation requirements and maximum fees list does not impact on injured workers’ access to, or eligibility for, diagnostic imaging services in accordance with the NSW Workers Compensation Legislation. Also, there are no changes to the GP referral processes currently in place.

Chiropractors, osteopaths and physiotherapists are registered with the Australian Health Practitioner Regulation Agency (AHPRA) and, except in relations to the treatment of police officers, fire fighters and paramedics, must be approved by SIRA to provide treatment and facilitate a safe and durable recovery at work.

Physiotherapy, chiropractic and osteopathy services are paid in accordance with the SIRA fees and rates orders.

To be reimbursed for treatment provided, you’ll need to submit an invoice to the insurer within 30 days of providing the service.

For more information visit the relevant page on the SIRA website:

• Physiotherapists
• Chiropractors
• Osteopaths

Accredited exercise physiologists must be approved by SIRA to deliver services in the NSW workers compensation system (except in relation to the treatment of police officers, fire fighters and paramedics).

Exercise physiology services are paid in accordance with the SIRA fees and rates orders.

To be reimbursed for treatment provided, you’ll need to submit an invoice to the insurer within 30 days of providing the service.

For more information visit the SIRA website exercise physiologists page.

Independent consultants must be approved by SIRA.

Independent consultants services are paid in accordance with the SIRA fees and rates orders.

To be reimbursed for treatment provided, you’ll need to submit an invoice to the insurer within 30 days of providing the service.

For more information visit the SIRA website independent consultants page.

Massage therapists do not require approval by SIRA to provide services.

Massage therapists services are paid in accordance with the SIRA fees and rates orders.

To be reimbursed for treatment provided, you’ll need to submit an invoice to the insurer within 30 days of providing the service.

For more information visit the SIRA website massage therapists page.

All medication must be prescribed by a qualified medical practitioner or dentist and supplied by a registered pharmacist.

Where possible, medication should be prescribed and supplied through the Pharmaceutical Benefits Scheme (PBS), unless the medication is not available on the PBS or there are extenuating circumstances.

A pharmacy account can be set up for medications approved under the claim. This allows for payment to be made directly to you by the insurer. For payment to be made directly to you, you should provide the insurer with:

• a dispensary computer generated tax invoice for PBS and private (non-PBS) medications supplied for treatment of the compensable injury
• the statement of account for over the counter and equipment items supplied to the person for treatment of their compensable injury.

Invoices and statements of account should contain the following information:

• pharmacy name, ABN, address, dispensing pharmacist's name
• invoice number and date dispensed
• total amount charged
• PBS item code (for PBS-dispensed medications)
• full description of the medication (including script number, generic name, form)
• quantity and strength of medication dispensed

For more information visit SIRA's Better practice guide.

Psychologists, social workers and counsellors must be approved by SIRA to provide services in the workers compensation system (except in relation to the treatment of police officers, fire fighters and paramedics).

Psychologists, social workers and counsellors services are paid in accordance with the SIRA fees and rates orders.

To be reimbursed for treatment provided, you’ll need to submit an invoice to the insurer within 30 days of providing the service.

For more information visit the SIRA website psychologists, counsellor and social workers page.

The SIRA workers compensation guide for allied health practitioners states that:

"With the exception of massage therapy, treatment delivered by non SIRA approved allied health practitioners is not governed by Workers Compensation Fees Orders. For services delivered by a non SIRA approved allied health practitioner that are similar in nature to that of a SIRA approved practitioner (for example hand therapy by an occupational therapist), it is recommended the relevant gazetted Fees Order be used as a guide for the cost of services.

Non SIRA approved allied health practitioners are to discuss their fees with the insurer and agree upon an appropriate charge at the time of requesting approval to deliver services. The fee should be similar to the amount customarily paid within the community for that type of treatment or service (except for massage therapists who have their own Fees Order). When the insurer notifies the treatment provider of the approval for treatment or services, the insurer should specify the costs approved."