Provider remuneration for compensation assessments

DVA pays medical providers for completing compensation assessments that have been requested by DVA. Payment is not guaranteed for reports or assessments completed without a DVA request or prior approval. DVA does not pay for reports requested by third parties, including veterans, advocates, solicitors or dependants.

Claiming payment

Medical providers should invoice DVA in accordance with the published fee guidance. GPs and specialists should submit invoices following guidance on Fee notes for GPs and specialists.

Using a Transaction Reference Number (TRN)

A Transaction Reference Number (TRN) is issued by DVA to support billing through the DVA Provider Upload Page.

The TRN:

• is provided by the delegate as part of the Request For Information paperwork
• applies only to the specific assessment request
• should not be used for any other assessment or investigation
• cannot be transferred to another provider.

Each compensation assessment attracts only one TRN, and therefore only one DCC and DCN item code, even if the assessment is split over two sessions. A single invoice should be submitted for all assessment related work.

For all compensation assessments except for a Psychiatric report request, invoices should include:

• Business name, address, ABN
• Veteran’s name, DVA file number
• Description, date, address of services
• Bank details for payment
• The title ‘tax invoice’ and invoice number
• The TRN
• The amount of GST charged
• Email address for remittance advice
• a ‘DCC’ item code reflecting the consultation length
• a ‘DCN’ item code if clinical notes or a more narrative description of care has been requested
• the page count of completed assessment forms.

Further details about invoice requirements can be found on Fee notes for GPs and specialists.

The DCC and DCN fees are intended to cover all diagnoses and conditions considered as part of that assessment and are not paid separately for each diagnosis. The amount payable will depend on specific assessment requirements. Permanent Impairment assessments generally involve more forms and will therefore usually attract higher remuneration, which reflects that this work usually takes longer.

Most compensation assessments require a consultation with the veteran. However, providers may choose to complete the requested forms at a separate time after the consultation. The DCC item can reflect the time spent:

• identifying information in clinical records
• consulting with the veteran
• completing the requested forms and assessment.

Requesting an above-fee payment

If a provider considers the published fee to be insufficient for a particular assessment, they may request consideration of an above-fee payment before the assessment is undertaken by:

• completing the D9551 form
• sending the form to compensation.trn.prior.approval@dva.gov.au. 

Assessments that may warrant consideration of an above-fee payment include those involving:

• a large number of claimed conditions or body systems, particularly where conditions are poorly defined or undifferentiated
• multiple comorbid conditions with overlapping symptoms or functional impacts
• exceptional clinical complexity requiring substantially more assessment time than is anticipated by the guidance.

Some veteran-specific factors may also increase assessment complexity and time requirements. Examples include:

• dementia or other significant cognitive disorders
• significant acquired brain injury, particularly where accompanied by mental health conditions
• profound hearing loss, blindness or other major communication barriers
• significant physical impairment that makes examination more time-consuming, such as amputations or reliance on mobility aids.

Approval is not automatic and will be considered on a case-by-case basis. DVA will consider the complexity of the claim and whether the circumstances are outside those normally expected for the assessment type. Above-fee payment approvals apply only to the individual assessment request. Approval for one assessment does not imply authorisation for above-fee billing for future assessments.

Non-GP specialists can apply the same fee guidance but may seek consideration of an above-fee payment where recognised specific clinical expertise is required for the assessment, and the fee guidance is not adequate for required time and effort to undertake the assessment.

Further details are available on Fee notes for GPs and specialists.

Circumstances that generally do not warrant an above-fee payment

Information regarding what is required of a provider during a compensation assessment is available from Compensation assessments.

Unfamiliarity with a veteran’s history or DVA processes, resulting in the potential need for additional consultation or reporting time.

DVA does not generally approve above-fee payments for the following activities as they are not a required part of the assessment:

• becoming familiar with DVA compensation processes or assessment requirements
• reviewing Statements of Principles, GARP or other legislative instruments
• providing information beyond the scope of the request
• reviewing records held outside the current treating practice
• undertaking literature reviews
• new-patient registration, intake or practice enrolment processes
• arranging or considering referrals for investigations or specialist review
• providing clinical management for issues identified during the assessment
• pre-reading of request paperwork
• administrative activities, including report uploading and invoicing.

In general the following types of requests are unlikely to be agreed to:

• Requests substantially above the fee guidance with no justification.
• Higher fees for experience or qualifications in military or veteran medicine.
• Additional time required due to not being the veteran’s treating doctor.

Billing case examples

Case study — Initial liability

A 52-year-old male veteran has submitted liability claims related to upper and lower limb and back conditions.

DVA sends a Request For Information to the nominated GP for diagnosis of the claimed bilateral knee osteoarthritis, bilateral shoulder osteoarthritis, right hand osteoarthritis, and lumbar spondylosis. 

The GP reviewed their own records and existing imaging reports, completing 5 Diagnostic Assessment forms for bilateral knee osteoarthritis, bilateral acromioclavicular joint osteoarthritis, bilateral rotator cuff syndrome, right hand osteoarthritis, and bilateral spondylolysis L5.  The expected consultation time for such an assessment by a treating doctor is 30-40 minutes.

Case study — Permanent impairment

A 48-year-old male veteran has submitted a claim for Permanent Impairment for their accepted conditions.

DVA sends a Request For Information to the nominated GP for an assessment of thoracolumbar spondylosis, tinea pedis, bilateral feet blisters, left ankle strain, bruxism, temporomandibular joint disorder, and gastroenteritis. 

The expected assessment duration is around 60 mins.