OR Services Description & Fees - RTW With The Injury Employer

These RTW with injury employer OR services are payable at an hourly negotiated rate plus GST agreed between agent and OR provider. In agreeing the negotiated rate, consideration may be given to the base hourly rate of $125.90 and the recommended rate of $132.05. These rates are indexed on 1^st July each year.

Code	Definitions	Qualifications
RC700 Fixed Fee	Initial Assessment The purpose of the Initial Assessment is to assist Agents in making informed decisions about OES. The report identifies the workers current work capacity, summarises the worker’s pre-injury duties, medical restrictions and functional limitations, proposes solutions to any perceived barriers to return to work and recommends whether OES should/should not commence. The OR provider must, in the Initial Assessment report, estimate overall what the RTW goal, cost and duration is expected to be achieved from OES. There is an expectation that the assessment occurs at the workplace wherever possible, involving the employer, worker, return to work coordinator or supervisor to identify suitable duties and to facilitate maintenance at or return to work following injury. This may also include advice regarding workstation, equipment modification or the provision of aids, appliances, apparatus or other material.	A qualified rehabilitation professional. This person has qualifications in a medical, health or related areas and would include a diploma, degree or graduate diploma in medicine, health science, behavioural science, social work or rehabilitation counselling or eligibility for registration as a Division 1 Nurse in accordance with requirements as established by the Nurses Board of Victoria.
RC701 Fixed Fee	OES Progress Reports Months 1 -5 The OR provider submits Monthly Progress Reports on the same date each month that the Initial Assessment was conducted. The report outlines the progress toward achieving the expected RTW goal, cost & duration, as highlighted in the Initial Assessment report and provides rationalisation as to why OES should continue.	A qualified rehabilitation professional
RC702 Fixed Fee	OES Progress Reports Months 7 – 11 Where OES is approved post 6 months, the OR provider submits Monthly Progress Reports on the same date each month that the Initial Assessment was conducted. The report outlines the progress toward achieving the expected RTW goal, cost & duration, as highlighted in the Initial Assessment report and provides rationalisation as to why OES should continue.	A qualified rehabilitation professiona
RC703 Fixed Fee	OES Progress Reports Post 12 Months Where OES is approved post 12 months, the OR provider submits Monthly Post 12 Month Progress Reports on the same date each month that the Initial Assessment was conducted. The report outlines the progress toward achieving the expected RTW goal, cost & duration, as highlighted in the Initial Assessment report and provides rationalisation as to why OES should continue.	A qualified rehabilitation professional
RC705 Fixed Fee	6 Month Progress Report The 6 Month Progress Report replaces the normal monthly Progress Report due at the 6 month mark. In this report, the OR provider must demonstrate where the worker has not achieved their goal, why OES should continue, given the amount of servicing already provided and why JSA is inappropriate.	A qualified rehabilitation professional.
RC710 Fixed Fee	12 Month Progress Report The 12 Month Progress Report replaces the normal monthly Progress Report due at the 12 month mark. In this report, the OR provider must demonstrate where the worker has not achieved their goal, why OES should continue, given the amount of servicing already provided and why JSA is inappropriate.	A qualified rehabilitation professional
RC715 Fee for Service	OES Servicing All activity must be billed under this code	A qualified rehabilitation professional
RC720 Fixed Fee	Incentive 1 Payable when the worker returns to 50% of their pre-injury hours	Not applicable
RC730 Fixed Fee	Incentive 2 Payable where the worker returns to 100% pre-injury hours and this is sustained for 4 weeks. The worker must not have had more than 3 working days where they have deviated from pre-injury hours during the 4 week period for this incentive to be paid.	Not applicable
RC740 Fixed Fee	Incentive 3 Payable where the worker returns to 100% pre-injury hours and this is sustained for 13 weeks The worker must not have had more than 5 working days in total where they have deviated from pre-injury hours during the 13 week period for this incentive to be paid.	Not applicable
RC750 Fixed Fee	Incentive 4 Payable where 100% pre-injury hours are sustained for 13 weeks and pre-injury duties/productive duties are also achieved at the completion of the sustainability period This incentive can also be paid where a worker not in receipt of benefits when OES commences, returns to pre-injury duties/productive duties	Not applicable
RC760 Fee for Service	Functional Assessment This assessment will consider the worker’s physiological &/or psychological functioning as they relate to current work capacity, the RTW goal & suitable employment options being pursued. A functional assessment is outside of OES and therefore OR providers should negotiate use of this service with the Agent. OR provider’s can highlight in an OES progress report that such a service is warranted however, approval and funds should be negotiated independent of OES.	Specialist in rehabilitation medicine. A Physiotherapist. An Occupational Therapist. An Occupational Physician
RC770 Fee for Service	Advice or assistance to the worker in obtaining Vocational Re-education Vocational re-education should be recommended whether suitable duties cannot be identified for the worker using their existing transferable skills however other options are likely to be available at the injury workplace or other workplace of the injury employer should re-education be undertaken. This assessment will consider the suitable employment identified for the worker & determine which type of course or retraining options are most likely to assist the worker to return to work with their pre-injury employer. A vocational re-education assessment is outside of OES and therefore OR providers should negotiate use of this service with the Agent. OR provider’s can highlight in an OES progress report that such a service is warranted however, approval and funds should be negotiated independent of OES.	A qualified rehabilitation professional. A vocational adviser. This person has received formal; qualifications in, &/or experience in employment services & knowledge of current labour markets.
RC780 Fee for Service	Work Conditioning The process of gradually increasing a worker’s physical & mental tolerances, to improve fitness &/or confidence in returning to suitable employment. It is preferable that wherever possible, this service emulates the tasks/activities relevant to the RTW goal & suitable employment being pursued. Work conditioning is outside of OES and therefore OR providers should negotiate use of this service with the Agent. OR provider’s can highlight in an OES progress report that such a service is warranted however, approval and funds should be negotiated independently of OES	A Physiotherapist. An Occupational Therapist. An Occupational Physician.
RC790 Fee for Service	Functional Education The process of educating the worker to maximise function & minimise the risk of subsequent injury to the worker particularly, an injury of the same kind. Functional education is outside of OES and therefore OR providers should negotiate use of this service with the Agent. OR provider’s can highlight in an OES progress report that such a service is warranted however, approval and funds should be negotiated independently of OES	A Physiotherapist. An Occupational Therapist. An Occupational Physician.
RC799 Travel	Reasonable travel costs may be approved to allow for workplace based OES to be undertaken. The OR provider must estimate the number of hours of travel needed to achieve the RTW goal as part of the OES Assessment Report & the funding request must nominate the estimated cost of travel. Agents should not approve more than 60 minutes one way unless the circumstances of the worker suggest lengthy or additional travel is required.	Not applicable

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