Medical and related services

Overview

Allied health practitioners play an important role in the NSW workers compensation scheme. Allied health practitioners are engaged to provide specialised expertise to identify a worker’s strengths and barriers to work, and to develop evidence-based strategies to treat their injury and maximise their recovery.

This guidance considers:

• the categories of allied health practitioners (SIRA approved and non-SIRA approved)
• the role of allied health practitioners
• communicating with allied health practitioners and the Allied Health Treatment Request (AHTR)
• fees and invoicing.

Practising in the NSW Scheme

In the NSW workers compensation scheme, allied health practitioners can be classified under two broad categories:

• SIRA approved allied health practitioners
• non SIRA approved allied health practitioners.

These categories are based on the practitioner’s discipline of practice and registration (or membership) as a health practitioner. Some differences exist between these two categories in terms of:

• processes for approval of services, and
• fees to bill the insurer.

SIRA approved allied health practitioners

Some allied health practitioners must be approved by SIRA before providing services in the NSW workers compensation scheme. These include:

• chiropractors, osteopaths, physiotherapists, and psychologists who have general registration with the Australian Health Practitioner Regulation Agency (AHPRA)
• exercise physiologists who are accredited with Exercise & Sports Science Australia (ESSA)
• counsellors who are full clinical members of the Psychotherapy and Counselling Federation of Australia (PACFA), or mental health social workers accredited with the Australian Association of Social Workers (AASW), or level 3 or 4 members of the Australian Counsellors Association (ACA).

SIRA approved allied health practitioners must complete a training program and meet and adhere to the requirements set out in the SIRA Guideline for approval of treating allied health practitioners before they can deliver services in the NSW workers compensation scheme.

Generally, practitioners in the disciplines listed above who are not SIRA approved cannot deliver treatment services to workers in the NSW scheme. Non-approved practitioners however can provide services to exempt workers, and to workers being treated in the public hospital system.

Non SIRA approved allied health practitioners

Non SIRA approved allied health practitioners include all other allied health disciplines that do not require SIRA approval.

Non SIRA approved allied health practitioners should adhere to the principles and procedures set out in SIRAs Workers compensation guide for allied health practitioners, except where the guide specifies the procedure only applies to SIRA approved allied health practitioners.

The role of allied health practitioners

The allied health practitioner’s role may include:

• conducting a detailed assessment of the worker and, where applicable, providing information to inform and/or confirm diagnosis, and develop and implement treatment strategies
• obtaining information from the insurer and/or employer to help with goal-setting and treatment interventions
• treating the worker in accordance with the Clinical framework for the delivery of health services
• setting expectations regarding worker recovery at/return to work, active participation in recovery, planning and treatment
• using the AHTR to inform the support team of the worker’s progress and capacity for work
• educating all parties about the health benefits of good work.

Clinical framework for the delivery of health services

Allied health practitioners should provide services in accordance with the Clinical framework for the delivery of health services. The framework outlines a set of guiding principles intended to support healthcare professionals in their treatment of an injury through:

• measurement and demonstration of the effectiveness of treatment
• the adoption of a biopsychosocial approach
• empowering the worker to manage their injury
• implementing goals focused on optimising function, participation and return to work
• basing treatment on the best available research evidence.

The allied health practitioner, while supporting and encouraging the worker in their recovery, should not advocate for the worker in relation to the management of their claim, litigation or other compensation processes.

Issuing a certificate of capacity

In response to the COVID-19 (Coronavirus) pandemic, amendments were made to section 44B of the Workers Compensation Act 1987 and the Workers Compensation Regulation 2016 (the 2016 Regulation) to permit SIRA approved treating physiotherapists and psychologists to issue second and subsequent certificates of capacity.

The treating physiotherapist or treating psychologist certifying capacity must be SIRA approved, and use a form approved by the Authority. The Certificate of capacity – treating physiotherapist or psychologist form is available on the SIRA website.

A SIRA training package is available for treating physiotherapists and psychologists on completing the Certificate of capacity.

If the worker has more than one type of injury and/or is receiving treatment by more than one practitioner, the treating physiotherapist or treating psychologist should consider whether the worker should be referred back to their nominated treating doctor or medical practitioner to certify their overall capacity.

See Insurer guidance GN 3.3 Certificate of capacity for more information.

Communication with allied health practitioners

Allied Health Treatment Request

The AHTR is the primary communication tool for allied health practitioners to inform the support team of the worker’s recovery and the provision of services.

The AHTR allows allied health practitioners to:

• describe the impact of the injury on the worker in terms of reported and observed signs and symptoms, as well as their capacity to engage in their roles at work, home and in the community
• set goals and empower the worker to be actively involved in their recovery
• outline an action plan
• demonstrate the effectiveness of treatment using measurable outcomes
• request approval of treatment services, including equipment needs and case conferencing
• indicate the anticipated timeframe for recovery
• receive an insurer decision about their treatment request.

Practitioners can request approval for up to eight treatment services on a single AHTR form. However, they should only request the number of sessions they believe the worker will need.

Following receipt of an AHTR, the insurer is to complete Section 7 of the form and return this to the allied health practitioner via email or fax. The insurer is to provide an explanation and additional documentation if their decision is to not approve or partially approve the services requested.

Questions about treatment

If an insurer has concerns regarding the duration, frequency, or nature of the treatment, or whether it is reasonably necessary, they should contact the allied health practitioner directly to discuss the issue. If this does not resolve the issue, the insurer can make a referral to an independent consultant.

An independent consultant is an allied health practitioner approved by SIRA to provide an impartial peer review of allied health practitioner treatment (either physical or psychological).

They assist insurers, allied health practitioners, workers and employers in the management of a claim to optimise worker health and recovery through work/return to work outcomes.

Insurers must use the independent consultant referral form to engage an independent consultant.

Fees and invoicing

Fees

Fees and practice requirements specify:

• the maximum amount payable for treatment services carried out for workers compensation claims
• the codes allied health practitioners are to use
• what various services include
• that workers are not liable for these costs.

Fees for allied health practitioners are set out in the following Fees and practice requirements:

• physiotherapists, chiropractors and osteopaths
• exercise physiologists
• psychologists and counsellors
• massage therapists
• hearing services providers
• independent consultants.

Treatment provided by an allied health practitioner not included in the list above is not covered by Fees and practice requirements. For these practitioners, the insurer should negotiate an appropriate fee before the start of treatment, taking into account existing Fees and practice requirements, and what would be customarily paid in the community.

No fees are payable for cancellation or non-attendance. Pre-payment for reports or services is not permitted.

Invoices

Invoices must meet SIRA invoicing requirements and should be submitted to the insurer within 30 calendar days of the treatment.

Insurers are to pay provider invoices promptly. Prompt payment is considered to be within ten calendar days or the provider’s specified business terms, whichever is later. It is preferable if payments to providers are made by Electronic Funds Transfer (EFT).

Interstate allied health practitioners

Sometimes NSW workers may be treated by interstate providers. Even though they are in a different state, these providers must adhere to the NSW workers compensation scheme requirements.

Interstate treatment providers delivering services to NSW workers do not need to be approved by SIRA (unless issuing certificates of capacity), however, they do need to meet the approval criteria (other than the completion of the NSW allied health practitioner training).

When invoicing, interstate practitioners should use the service provider code ‘INT0000’ if they do not have a SIRA approval number. In addition,the invoice must include their AHPRA registration number or professional association accreditation/membership number if their discipline is not eligible for registration with AHPRA. Fees charged cannot exceed the maximum fee payable in NSW.