Information for Occupational Rehabilitation (OR) providers
Why WorkSafe has a provider billing review
WorkSafe conducts periodic reviews of payments made to providers for medical, allied health and OR services. The primary focus of our Billing Review Program (BRP) is to ensure that payments made to these providers are appropriate and comply with WorkSafe policies and fee schedules.
Information WorkSafe may request for reviews
When seeking information and documents directly from an OR provider as part of the BRP, WorkSafe may formally notify you of a requirement for worker information and records and documents made by you pursuant to section 552 of the Workplace Injury Rehabilitation and Compensation Act 2013.
This section provides the authority for the supply of the requested information and documents to WorkSafe. As such, an OR provider is not required to obtain consent from injured workers to release the information and documents requested under this provision.
If you are a contracted provider, WorkSafe may, in some circumstances, rely on the audit provisions contained in the relevant OR provider's Agreement for provision of occupational rehabilitation services when requesting information and documents.
How WorkSafe notifies providers about reviews
WorkSafe will contact providers about a review before a visit and arrange a time to collect the requested information and documents. These documents will be returned to providers within an agreed timeframe. WorkSafe may also contact other parties, including hospitals and other health facilities, to obtain information and documentation, to help with the billing review.
WorkSafe seeks to communicate and obtain requested information and documentation from providers in a co-operative way.
In some circumstances occupational rehabilitation, WorkSafe also has the authority to inspect, examine or make extracts from, or copies of any information within premises that may be required to complete a billing review.
The information and documentation obtained by WorkSafe is not used for any other purpose than the billing review and will not be used to manage injured worker claims.
Confidentiality and secure storage of patient information
WorkSafe is required to comply with the Information Privacy Act 2000 (Vic), the Health Records Act 2001 (Vic) and the Information Privacy Principles and Health Privacy Principles set out in those Acts.
Information collected from providers as part of the Billing Review Program is managed in accordance with WorkSafe privacy policies, and is not placed on claim files.
What is considered in a review
A WorkSafe billing review focuses on ensuring that payments made to OR rehabilitation providers are appropriate and comply with WorkSafe policies, fee schedules and any relevant agreements.
When conducting reviews, WorkSafe considers: