Physiotherapy services guidelines

The provision of physiotherapy services

These guidelines are in line with the Workplace Injury Rehabilitation and Compensation Act 2013 (WIRC Act) and the Accident Compensation Act 1985.

WorkSafe will have regard to these guidelines when making decisions for the provision of physiotherapy services to people who have an accepted claim under the Victorian Workers Compensation Scheme.

Throughout these guidelines, any reference to WorkSafe also includes WorkSafe’s agents and self-insurers.

Physiotherapy services

WorkSafe can fund physiotherapy services to assist people to effectively recover from workplace injuries and safely return to work and life.

Physiotherapists are qualified professionals whose focus is on the structure and movement of the human body. They work with people of all ages to improve physical mobility and movement related to general musculoskeletal conditions and neurological and respiratory conditions. They work across the spectrum from health prevention to acute and rehabilitation care.

Physiotherapists can provide services, together with other health professionals, to plan and manage treatment. A treatment plan will consider a person’s lifestyle, activities and general health.

Clinical Framework for the Delivery of Health Services

WorkSafe has developed the Clinical Framework for the Delivery of Health Services (Clinical Framework) to set out key principles for the delivery of services to workers.

The Clinical Framework is based on the following principles.

• Measurement and demonstration of the effectiveness of treatment.
• Adoption of a biopsychosocial approach.
• Empowering the injured worker to manage their injury.
• Implementing goals focused on optimising function, participation and/or return to work/health.
• Base treatments on best available research evidence.

WorkSafe expects that all health professionals providing services to workers integrate the principles of the Clinical Framework into their daily practice.

What we can pay for

WorkSafe can pay the reasonable costs of physiotherapy services a person needs as a result of a work-related injury or illness under Victorian workers compensation legislation.

The treatment or service must meet the following criteria.

• Be clinically justified, safe and effective.
• Be likely to achieve measurable improvement in a person’s functioning.
• Promote progress toward a person’s functional independence, participation and self-management.
• Be for rehabilitation purposes for a work-related injury only.
• Be delivered in line with the Clinical Framework.

WorkSafe will periodically review a worker's entitlement to physiotherapy services to ensure the treatment and services remain reasonable for the work-related injury and/or illness and are payable under the legislation.

Group consultations

WorkSafe can pay the reasonable cost of group consultations provided by a physiotherapist.

Group consultations involve 2 or more patients receiving constant overall supervision and intermittent attention. The maximum number of patients in a group should not exceed 6.

Restricted consultations

Restricted consultations require prior written approval from WorkSafe. WorkSafe can pay the reasonable costs of restricted consultations where a worker requires treatment beyond that of a standard consultation. This may include:

• moderate to severe acquired brain injury
• crush injuries
• extensive burns
• spinal cord injuries
• multiple orthopaedic fractures
• limb amputations.

The Restricted Consultation application form must be completed by a physiotherapist to apply for approval to use the restricted physiotherapy consultation item number. It is recommended that physiotherapists do not bill the restricted item consultation item number until they have been advised by WorkSafe in writing that their application has been accepted.

Physiotherapists can be reimbursed by WorkSafe for the completion of the Restricted Consultation application form.

Consultations in the community

WorkSafe can pay the reasonable costs of a consultation undertaken in a community setting, such as at a hospital, at home or at a worker's workplace, where clinically justified.

WorkSafe expects the worker to seek treatment from a provider in their local area.

Return to Work Case Conference

A Return to Work (RTW) case conference is used to facilitate continuity of care, return to work and communication between relevant parties. If a RTW case conference is required, contact must be made with WorkSafe to facilitate the case conference and ensure appropriate representation from WorkSafe. The worker, employer, and any member of the treating team can also be involved in the case conference.

Administration and any follow up post RTW case conference is included in the RTW case conference fee, as indicated in the physiotherapy services fee schedule.

Travel

Travel is only payable with prior written approval from WorkSafe.

A request for travel must be accompanied by a request to WorkSafe detailing the following.

• Worker's name and claim number.
• The specific conditions and injuries to be treated.
• The clinical justification as to why travel is required.
• The approximate distance and cost per episode of travel (round-trip).
• The number of travel episodes requested.

WorkSafe can pay the reasonable costs of travel on a per kilometre basis for physiotherapists providing treatment outside their clinic. Travel is defined as the physiotherapist driving a registered motor vehicle from their clinic address to an approved consultation outside of the physiotherapist’s clinic.

Approved consultations outside of the physiotherapist’s clinic are paid at the standard or extended consultation rate, as applicable. The cost of travel is paid on a per kilometre basis.

For more information refer to the physiotherapy fee schedule.

WorkSafe expects a worker to seek treatment from a physiotherapist within their local area.

Travel can be paid only where:

• no other physiotherapist offering an equivalent service is situated within a 30-kilometre round trip of the worker
• travel to the worker is clinically justified.

The per kilometre rate paid for travel is different for regional and metropolitan areas. Travel is paid at the applicable rate where most of the travel occurred. For example, 10km in a regional area and 20km in a metropolitan area would result in payment for 30km of travel at the metropolitan rate. Metropolitan and regional areas are as defined by the Victorian Department of Health.

Travel must be recorded from the rooms nearest to the worker's location where a physiotherapist has more than one practice address.

The physiotherapist must record the distance from one appointment to the next when workers are treated consecutively, not from each appointment to the practice.

When invoicing for travel, the physiotherapist must record the:

• number of metropolitan and/or regional kilometres travelled
• applicable metropolitan or regional rate
• item number.

WorkSafe can also reimburse the reasonable travel expenses of a worker attending a physiotherapist.

Services we will not pay for

Under the Victorian workers compensation legislation, WorkSafe cannot pay for the following physiotherapy services.

• Services that are not required as a result of a worker’s accepted injury or illness.
• Services for a person other than the person with an accepted claim.
• Services that are not a reasonable cost as determined in accordance with the Victorian workers compensation legislation.
• Services provided outside of Australia without prior written approval from WorkSafe.
• Services provided by a person who cannot practice in the relevant profession under the Health Practitioner Regulation National Law because:
  • they are not registered
  • they are registered as a student
  • they hold provisional registration.

Under WorkSafe’s determination of reasonable cost, WorkSafe will not pay for costs relating to the following.

• More than one initial consultation by the same provider or clinic unless there are exceptional circumstances. For example, following a hospital admission or surgery, or where a significant period of time has elapsed since the injured worker last received treatment.
• The provision of multiple disciplines or concurrent physical treatments/consultations (for example early intervention physiotherapy, physiotherapy, chiropractic, osteopathy or acupuncture) with exceptions such as group exercise or group hydrotherapy.
• Group consultations which do not involve 2 or more patients receiving constant overall supervision and intermittent attention. The maximum number of patients in a group should not exceed 6.
• Pharmacy items such as creams and gels supplied by health professionals.
• Treatment or services subcontracted to or provided by a non-registered provider.
• Fees associated with cancellation or non-attendance or services not provided to the worker.
• Services where their rendering cannot be substantiated by contemporaneous clinical records and/or attendance records.
• Treatment or services provided by telephone or other non-face to face mediums that do not align with WorkSafe's telehealth policy.
• Consumable prosthetics, aides and appliances used in the course of the consultation. For further information, see the WorkSafe policy for equipment and related services.
• Consultations provided more than once on the same day to the same worker.
• A single service billed to more than one claim held by the injured worker.
• Unsolicited treatment or consultation with a worker. Telephone calls and telephone consultations between providers and workers, and between other providers, including hospitals, that do not align with WorkSafe's telehealth policy.
• Treatment, services, prostheses or equipment where there is no National Health and Medical Research Council level 1, or level 2 evidence that the treatment, services, prostheses or equipment is safe and effective. For more information, see the WorkSafe policy for non-established, new or emerging treatments and services.
• Treatment that does not align with the Clinical Framework.

Subsequent certificates of capacity

A physiotherapist can issue a subsequent certificate of capacity if the worker's capacity for work is affected because of a work-related injury. It is valid for a maximum of 28 days, unless special reasons exist and the agent or self-insurer approves.

A copy of the certificate must be retained in the worker’s clinical records.

Only a medical practitioner can issue the first certificate of capacity.

Certificates of capacity should not be provided to workers by telehealth. Read WorkSafe’s telehealth policy for more information.

Certificates of capacity are not payable under this policy.

How much we can pay

WorkSafe will pay for physiotherapy services in line with the Physiotherapy fee schedule.

Sometimes there is a difference between what a provider charges and what WorkSafe will pay as the reasonable cost. If the provider charges more than what WorkSafe will pay, workers will need to pay the difference. In this instance, WorkSafe recommend the provider advise the worker prior to providing any services.

WorkSafe's invoice requirements

There are defined instructions for invoicing WorkSafe for EIPF services:

Who can provide these services

Physiotherapy services are delivered by providers who are registered under the Health Practitioner Regulation National Law to practise in the physiotherapy profession (other than as a student).

WorkSafe will only fund physiotherapy services delivered by providers who are registered with WorkSafe and satisfy the following conditions.

• Registered with the Physiotherapy Board of Australia (other than as a student)
• Hold the requisite insurance coverage to deliver physiotherapy services.

Find out how to register as a WorkSafe provider.

Accessing services

WorkSafe does not require any information from a physiotherapist before commencement of initial treatment for a worker's work-related injury. However, once treatment has started the physiotherapist must submit to WorkSafe a WorkSafe Allied Health Recovery Management Plan (AHRMP) including baseline measures and psychosocial risk questionnaire screening after the initial treatment has commenced. This must be submitted within the first 5 sessions. If the worker has previously attended a different physiotherapy clinic, an AHRMP is expected from the new clinic within the first 5 sessions.

For workers that are part of the Community Integration Program the request, approval and submission of outcome measures for services will form part of the independence planning process.

The initial consultation fee includes the completion of the WorkSafe Allied Health Recovery Management Plan within the first 5 visits.

Subsequently, a WorkSafe AHRMP with updated outcome measures and treatment goals may be requested by the agent. The agent reserves the right to determine whether the additional requested services are reasonable in the circumstances of the worker's claim.

A copy of the AHRMP must be retained in the worker’s clinical records.

WorkSafe response

For services that do require prior approval, WorkSafe will respond within 10 working days to advise if:

• the request has been approved
• the request has been denied
• further information is required to make a decision.

Where further information is required, WorkSafe will advise whether the request has been approved or denied within 10 working days of receipt of the additional information.

To assist in making a decision regarding a request for further physiotherapy services, a request may be reviewed by a WorkSafe Medical Advisor and/or Clinical Panel. The Clinical Panel and/or Medical Advisor may contact the requesting physiotherapist to seek further information and/or discuss the proposed treatment prior to making a recommendation to the agent regarding the request.

WorkSafe will respond to the request when they have received the recommendations.

Service delivery expectations

WorkSafe expects that all providers delivering physiotherapy services as part of the Victorian workers compensation scheme follow the below principles.

• Provide culturally safe and respectful services.
• Protect the person’s human rights and report any concerns of abuse, neglect or discrimination to an appropriate regulatory or complaints body.
• Support the person to maximise their independence, promote recovery and self-advocacy.

WorkSafe also expects that any treatment provided is reasonable, clinically justified, outcome focused, and in line with the clinical framework.

WorkSafe has reporting and engagement expectations for all providers delivering physiotherapy services to workers. WorkSafe expects providers to communicate, collaborate and provide information to WorkSafe and other relevant parties as required.

For example:

• Providers should work with treating health practitioners or other providers, such as medical practitioners to enable the most appropriate treatment
• Providers should work with occupational rehabilitation providers, treating health practitioners and employers in relation to return to work.

Providers are required to comply with the requirements set out in these guidelines and in the Application for registration to provide services to workers.

If a provider does not meet these requirements or WorkSafe has concerns about the provider’s conduct or services delivered, WorkSafe may take appropriate action in accordance with the legislation.