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.
Non-compliant activities can result in:
- an education process about our requirements
- referral for an audit (PDF 316 KB) — please refer to this overview of the process
- debt recovery action, where you will have to repay funds that we paid to you.
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 audit attention. Audits can lead to debt recovery.
Excessive daily consultations
Providers who claim excessive services to DVA clients in a single day will receive education or audit attention.
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.
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.
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.
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 51- 56 of the Notes for Allied Health Providers for more information.
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.
Extended consultations are only applicable in certain circumstances. If you claim high proportions of extended consultations you will be referred for audit. Refer to your specific Fee Schedule for more information:
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 61 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.
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.
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.