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Frequently asked questions about payments and invoicing

Is a nominated treating doctor entitled to charge for completion of each NSW workers compensation certificate of capacity?

No, only the initial certificate is chargeable. If a different treating doctor has already issued a certificate, no further certificates can be paid for.

Can cancellation or non-attendance fees be charged?

No. SIRA Fees Orders do not permit cancellation fees by a treating medical practitioner.

Can I ask a worker to pay for their consultation?

SIRA does not support doctors billing a patient privately and directing the worker to recover the costs from their insurer/employer, as this may place undue financial stress on the worker. The best outcome for the worker is for the doctor to invoice the insurer directly.

If however the claim is disputed, the doctor should confirm with the insurer first, that the worker has received payment of weekly benefits. If the worker is receiving payment at the time of consultation, the doctor should also be paid by the insurer during this period. If no payments have been made to the worker, you may invoice Medicare for the consultation. If you have any questions regarding payment, speak to the insurer or call our Doctors Helpline on 1800 661 111.

Can I charge for reading and writing letters, reports and plans and participating in case conferences?

A communication fee can be charged for a reasonable amount of time spent in the management of an injury, when over and above that required in normal clinical practice for a non-workers compensation patient, whether verbal, in writing or face to face. Payment classification code WCO002 should be used for this purpose.

When is it appropriate to invoice using a Level C consultation?

SIRA schedules for medical services are based on complexity, rather than time spent. You must be able to justify invoicing a Level C consultation if requested by the insurer. Good case notes will assist with this. Services invoiced above Level B consultations should include consideration of the following to enable assessment of the complexity of the consultation:

  • nature of the condition
  • time since the work related injury or illness was sustained
  • changes in treatment, management, work restrictions and/or capacity for work during the consultation
  • frequency of consultations with the nominated treating doctor.

Can I charge for faxing?

Sending a fax is not chargeable. The time taken to prepare the information to be faxed can be charged using code WCO002.

Can I charge for communicating with other treatment practitioners about the worker’s treatment?

In most cases, communication regarding treatment is considered a usual interaction between a nominated treating doctor and other practitioners and cannot be charged as a case conference item.

However, if the communication is regarding return to work issues, or the communication extends beyond that which would be required for a non-workers compensation patient, then it is chargeable.

Can I charge for the time it takes to edit or redact information that does not relate to the worker’s injury?

Yes. You can charge for the time spent to edit a file using code WCO002.

What do I do if the worker's claim is disputed?

Regardless of the status of the claim, if the worker has a genuine medical condition, it is important they receive the treatment required. If a claim is disputed, treatment can be provided through the Medicare system. If the claim is accepted at a later date, Medicare will recover the costs from the insurer.

Who pays the nominated treating doctor if a claim is disputed and there are outstanding fees payable?

If the claim is disputed the insurer should pay all fees up to the date the claim is disputed. It is usual practice for the insurer to let you know that the claim has been disputed. If you have not been informed you should submit any outstanding invoices as soon as possible to the insurer. The worker is ultimately responsible for paying for treatment if a claim is not accepted or for treatment provided after a claim is disputed.

How do I bill for a service that is not on the AMA List of Medical Services and Fees?

You cannot bill for medical services that are not listed in the AMA List of Medical Services and Fees or the SIRA Workers Compensation Fees Orders.

How much time should I allocate for a case conference?

The worker may have their usual consultation with you before or after the case conference. You may need to allow time for two appointments: one for the case conference and the other for the consultation. The person requesting the case conference should provide an agenda with key points to be discussed, giving you some idea of how long the conference will take. Keep a record of the duration for invoicing purposes (note: payment classification code WCO002 should be used for invoicing of case conferences). See 'The worker's support team' for more information on case conferences.