A worker is entitled to recover costs for their reasonable medical and related expenses. These fall under the heading of approved treatments and include such things as, visits to and treatments by the worker’s general practitioner and specialist, physiotherapist and occupational therapist.
See the Rates, fees and payments page to view how WorkCover WA quantifies these entitlements.Charging for medical treatments
WorkCover WA specifies rates billable under the workers’ compensation system for the most commonly used medical services (also known as ‘scheduled items’). These rates (or ‘scheduled fees’) represent the amount that the insurer will reimburse the worker for the treatment provided. If a service provided to an injured worker does not have a scheduled fee, the fee shown in the Australian Medical Association’s List of Medical Services and Fees will usually apply.
If the claim is denied, the injured worker is responsible for prior and future treatment costs and should forward such accounts to Medicare (and/or their private health fund) for a rebate.
Disputes over unpaid invoices should first be taken to your patient’s employer or insurer. If you are unable to resolve the dispute you can lodge an application with the Workers’ Compensation Conciliation Service.
Medical practitioners can use the MBS number as their code – see the Medicare Benefits Schedule website for information.
Practitioners other than doctors can use the service codes available on the Rates, fees and payments page.
Service code not available?
If the service code is not listed among WorkCover WA’s scheduled items, the code may be found in either the Australian Medical Association’s List of Medical Services and Fees, or on the Medicare Benefits Schedule website. You should discuss the payment of the service fee with the workers’ compensation insurer – the fee shown in the AMA’s List is usually acceptable to the insurer in these cases. Be sure to include a clear description of the service provided on your invoice to the workers’ compensation insurer.
Billing practices for medical and radiology services
In 2018 WorkCover WA released a Notice explaining that medical fees are to be based on the applicable WorkCover WA fee or AMA fee (for unscheduled items). The Notice also reinforced long standing AMA and MBS rules regarding the complete medical service principle, multiple operation rule and mutually exclusive principle.
WorkCover WA has recently initiated a broad review of medical fees and services in the WA workers’ compensation scheme. The review will examine medical fee relativities and billing rules in other regulatory systems. The overall aim is to ensure medical costs are reasonable and billing rules are consistently applied.
While WorkCover WA supports the AMA and MBS rules and principles as outlined in the Notice, WorkCover WA has decided to remove the Notice while the review is in progress.
Nonetheless, all service providers are expected to remain cognisant of WorkCover WA’s schedules fees, AMA fees (for unscheduled items) and to provide transparency in the billing of medical services.
To this end WorkCover WA, in conjunction with insurer representatives, has developed a surgery proposal template to provide transparency about billing for planned surgeries for injured workers. A copy is available here.