Common compliance issues for allied health providers

We have identified the most common compliance issues with allied health provider claiming. We encourage you to read through these, so you are aware of potential risks and can remain compliant.

Back to top

Non-compliant activities

Non-compliant activities can result in:

• an education process about our requirements
• referral for an integrity assessment (PDF 263 KB) — please refer to this overview of the process
• debt recovery action, where you will have to repay funds that we paid to you.

Back to top

Excessive services to clients

Most health disciplines have a usual clinical pathway (initial higher intensity treatment tapering to cessation and or periodic assessment). Providers delivering treatments outside usual pathways (excessive services or duration of treatment) will receive education or assessment attention. Assessments can lead to debt recovery.

Back to top

Excessive daily consultations

Providers who claim excessive services to DVA clients in a single day will receive education or assessment attention.

Back to top

Group sessions claimed as individual treatments

Some health disciplines allow you to deliver individualised clinical treatment within groups of up to 12 participants. Where this is the case, claims for treatment should be made using the ‘Group session’ item code and fee, as advised in the Fee Schedule. You must not claim group sessions as individual treatments.

Back to top

Using the correct item code

Claim the right code for the service you provided. Some providers claim services that attract a higher fee (like home visits) when treatment is provided in clinic rooms or via telehealth. Claims incorrectly paid at higher rates are required to be repaid.

Back to top

Consumables

Some health disciplines are able to claim consumables associated with treatment. It is not expected that every individual service will always attract a consumable charge.

Back to top

Prior financial authorisation

Some services require you to seek our approval or financial authorisation before you start treatment. These services are outlined in the Fee Schedules and Notes for Allied Health providers. If you do not seek prior authorisation or approval you may be required to repay money. See Clauses 59 - 64 of the Notes for Allied Health Providers for more information.

Back to top

Multiple same day consultations/services

Most consultations and services are limited to one per day, per client. Billing in excess of limits will attract debt recovery action.

Back to top

Extended consultations

Extended consultations are only applicable in certain circumstances. If you claim high proportions of extended consultations you will be referred for assessment. Refer to your specific Fee Schedule for more information:

Back to top

Kilometre allowance

A mobile provider with no fixed practice location or who is not registered in a ‘usual place of business’ cannot claim kilometre allowance for any travel to see a DVA client, regardless of meeting DVA travel requirements.

For providers with a fixed practice location, you can claim the allowance but there are restrictions (refer to Clause 69 of the Notes). If you provide treatment only in a client’s residence we will ask you to justify kilometre allowance claims or repay money.

Back to top

You are responsible for your provider number

If someone else does your claiming or billing for you, you should make sure they have not made any mistakes. Claims made in your name are your responsibility. You will be held accountable for any errors.

Register with Services Australia for HPOS (Health Professional Online Services) to check claiming online.

Back to top

Figurehead billing

Every health professional who treats DVA clients must be registered with Medicare/Services Australia and have their own provider number. Providers cannot ‘share’ provider numbers. Multiple professionals cannot claim under the one provider number.

Back to top