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					                          Notes for Physiotherapists




         IMPORTANT NOTICE

                                  for

    Physiotherapists


This package contains your replacement Notes for Physiotherapists,
supplied by the Department of Veterans’ Affairs (DVA). Please
insert the Notes in your blue DVA folder ‘Information for Providers’.

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        Notes for Physiotherapists




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            Notes for Physiotherapists




           NOTES FOR
        PHYSIOTHERAPISTS




           1 October 1999




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                              Notes for Physiotherapists




                               FOREWORD




Physiotherapists play a key role in providing treatment for veterans. With the
ageing of veterans, the role is increasing in importance.

The Repatriation Commission and its administrative arm, the Department of
Veterans’ Affairs (DVA), look forward to continuing to work closely with
physiotherapists in the support of veterans. The Notes explain the procedures to
be followed when physiotherapists provide treatment for the 350,000 veterans
eligible for health care services.

Should you have any suggestions on further improving the arrangements for
physiotherapy, please contact the DVA State Office for your State or Territory.
The addresses and telephone numbers are listed in the Notes.




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        Notes for Physiotherapists




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                           Notes for Physiotherapists


                     TABLE OF CONTENTS

1       BACKGROUND
1.1     The Role of DVA       ..………………………………………….                   11
1.2     The DVA Health Care Program      …………………………..               11
1.3     Notes for Physiotherapists …………………………………..                  11
1.4     Relationship between DVA and Health Care Providers ..…      12
1.5     The Local Medical Officer Scheme …………………………..               12


2       ADMINISTRATIVE ARRANGEMENTS
2.1     What DVA Pays For …………………………………..……….                       13
2.2     Who Can Provide Physiotherapy Services ………………..….           13
2.3     Registration with DVA       ...…………………………………                14
        2.3.1 Registration Process ...…………………………………                 14
        2.3.2 Use of Locums         ..………………………………….                15
        2.3.3 No Obligation on DVA          .…………………………..           15
        2.3.4 Withdrawal from Contractual Arrangements with DVA     15
2.4     Transfer of Veterans ………………..………………………….                    15
        2.4.1 Transfer of Your Veterans .…………………………..               15
        2.4.2 Transfer of Veterans to You …………..……………….             16
2.5     Fees ..………………………………………………………….                              16
2.6     Accounts       ...…………………………………………………                       17
        2.6.1 Group Practices       ..………………………………….                17
        2.6.2 Accounts for Services Rendered by a Locum      .…..   17
2.7     Standards of Care    …………………..……………………….                    17
        2.7.1 Professional and Ethical Standards …………………...         17
        2.7.2 Continuing Education          …..……………………….           18
2.8     Discharge Planning ………………………...…………………                      18
2.9     Non-Compliance       ..………………………………………….                    18




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                            Notes for Physiotherapists


3       ELIGIBILITY FOR TREATMENT
3.1      Eligibility   ...…………………………………………………                         19
3.2      Repatriation Health Cards    ...…………………………………                19
3.3      Allied Veterans Resident in Australia ..………………….             20


4       TREATMENT GUIDELINES
4.1      Referral       ...…………………………………………………                        21
4.2      Patient Care Plan      .…………………………………………..                   22
4.3      Treatment Limits       .…………………………………………..                   23
         4.3.1 Extended Consultation         …………………………...            23
         4.3.2 Hydrotherapy …………………………………………...                       23
         4.3.3 Gymnasium Programs            …………………………...            24
4.4      Prior Financial Authorisation       ...…………………………            24
         4.4.1 When is Prior Financial Authorisation Required? ...…   25
         4.4.2 How is Prior Financial Authorisation Obtained?  ...…   26
4.5      Monitoring …...………………………………………………                            26
4.6      Auditing       ...…………………………………………………                        27
4.7      Travel Expenses        .…………………………………………..                   27
4.8      Home Visits ……………….…………………………………..                           27
4.9      Nursing Home Visits ..………………………………………….                      27
4.10     Public Hospital Visits …………..……………………………….                   28
4.11     Advice from DVA        ..………………………………………….                   28
         4.11.1 DVA State Office Contact List       ..………………….        28
4.12     Aids and Appliances …………………………………………...                      29
         4.12.1 Eligibility for Aids and Appliances …………………...        29
         4.12.2 PH91 (Physiotherapy Treatment Aids)       …………...     29
         4.12.3 Rehabilitation Appliances Program (RAP) …….……..       29
         4.12.4 Prescribing Aids and Appliances Under RAP      …...   29
         4.12.5 Prescriber Responsibility …………………………...               30




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5       TERMS AND CONDITIONS OF REGISTRATION AS A
        HEALTH PROVIDER WITH DVA
5.1     Definitions / Glossary ……..…………………………………….             31
5.2     Precedence ...…………………………………………………                      32
5.3     Quantity of Business ……………………..…………………….               32
5.4     Provision of Health Services and Payment …………………...    32
5.5     Provider Qualifications       ..………………………………….         32
5.6     Quality of Health Services ...…………………………………            33
5.7     Inappropriate Servicing       ...…………………………………         33
5.8     Amendment of Notes ……………………..…………………….                 34
5.9     Right of Commonwealth to Recover Money …………………...      34
5.10    Subcontracting         .…………………………………………..             34
5.11    Access to Documents ………………..………………………….                35
5.12    Protection of Personal Information .…………………………..       35
5.13    Insurance and Indemnity       …………...………………………         37
5.14    Negation of Employment and Partnership …………………...      38
5.15    Compliance with Laws          ..………………………………….         38
5.16    Law Applying to the Deed of Agreement    ..………………….    38
5.17    Liability      ………………………...…………………………                  38
5.18    Assignment ……………………………….…………………..                      38
5.19    Waiver         ………………...…………………………………                  39
5.20    Variation      ………………………………………...…………                  39
5.21    Dispute Resolution ……………………..…………………….                 39
5.22    Termination of DVA Registration ……………….…………..          40
5.23    Notices        …………………………...………………………                  42



                         APPENDICES
A       ACCOUNTS PAYMENT PROCEDURES
1       The DVA Accounts Payment System         …..……………….     45
        1.1 Background      ………………………..………………….                45
        1.2 Provider Registration ……………………...……………             45
        1.3 Payment to Different Names and Addresses …….……..   46


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                            Notes for Physiotherapists


2       Billing Procedures   ……………………………..…………….                      46
        2.1 Billing DVA      ………………………………..………….                      46
        2.2 Claim for Treatment Services (Form D1217) …….……..         47
        2.3 Health Practitioner Service Voucher (Form D1221) ...…     48
        2.4 Lodgement of Claims ...…………………………………                      49
        2.5 Required Timeframe for the Lodgement of Claims   ...…     50
        2.6 For Faster Processing ...…………………………………                    50
3       Receiving Payment ……………………………..…………….                         50
4       Payment Problems …………………………………..……….                          52
        4.1 Non-payment of Claims          .…………………………..              52
        4.2 Relodgement of Claims ...…………………………………                    53
        4.3 Adjustments      ……………………………..…………….                      53
5       Inquiries     ...…………………………………………………                          54
6       Contact Numbers and Addresses for the HIC …………………...          54


B       REPATRIATION TRANSPORT
1       Introduction ……………………………………….…………..                           57
2       Repatriation Transport Scheme     ..………………………….               57
3       Eligibility for Travel Assistance ..………………………….               57
4       Acceptable Means of Travel ...…………………………………                   57
5       Claims by Veterans for Reimbursement of Travelling Expenses   58
6       Provider Certification ………………………..………………….                    58
7       Taxi Transport          …………………………………………...                   58
8       Community Transport Groups        .…………………………..               59
9       Attendants      ...…………………………………………………                        59
10      Further Information ………………..………………………….                       60


C       SCHEDULE OF FEES
        PHYSIOTHERAPY …………………...………………………                             63




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                              Notes for Physiotherapists

1       BACKGROUND
1.1     THE ROLE OF DVA
The Repatriation Commission (‘the Commission’) is responsible for the general
administration of the Veterans’ Entitlements Act 1986 ( ‘The Act’ ).

Under the Act, the Commission is authorised to prepare Treatment Principles, a
document legally binding on the Commission, setting out the circumstances under
which financial responsibility is accepted for the health care of veterans.

A ‘veteran’ is a veteran, war widow(er) or a dependant of a veteran who is eligible
for benefits or treatment from the Commonwealth or the Commission in
accordance with the Veterans’ Entitlements Act 1986 or other legislation in the
Veterans’ Affairs portfolio.

The Department of Veterans’ Affairs (DVA) provides administrative support to
the Commission.


1.2     THE DVA HEALTH CARE PROGRAM
The DVA health care program provides access for veterans to services which will
assist them in coping with disabilities and improving their health and well-being.


1.3     NOTES FOR PHYSIOTHERAPISTS
This information is based on the provisions of the Act and the Treatment
Principles, and is aimed at helping to provide services to veterans.

The Notes form part of the Deed of Agreement with the Commission. The
information contained herein is binding. Any breaches may lead to formal legal
proceedings or termination of DVA provider status.




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                                 Notes for Physiotherapists

1.4        RELATIONSHIP BETWEEN DVA AND HEALTH
           CARE PROVIDERS
The continuing improvement of DVA's relationship with health care providers is
an important element in DVA’s strategy of achieving quality health care for
veterans.

A decision made by the Commission in 1996 requires DVA to seek written
agreements with its health care providers in order to achieve a clear definition of
the rights and obligations of all parties. Written agreements between health care
providers and DVA assist in forging an alliance in which the provision of quality
care for veterans is the joint objective.

Physiotherapists who wish to provide services to veterans at Commission expense
are, therefore, required to sign the ‘Deed of Agreement’ with DVA. This will
ensure that you are registered with DVA as a health care provider.


1.5        THE LOCAL MEDICAL OFFICER SCHEME
A Local Medical Officer (LMO) is a general medical practitioner in private
practice who provides medical services to veterans under DVA’s health care
arrangements.

The LMO acts as the coordinator of a veteran’s health care, which involves:

•       preparing an annual health care plan for some veterans;

•       arranging referrals to medical specialists, allied health professionals and
        community nurses; and

•       in limited circumstances, obtaining prior financial authorisation from DVA
        for services to veterans.

Normal referral protocols require that, in the interest of the care of the veteran,
there will be adequate communication between the LMO and the health care
providers to whom the LMO has referred veterans. It is essential that you keep
the LMO, as the veteran’s health care coordinator, informed about the progress
and outcomes of the treatment that you provide to a veteran.




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                                 Notes for Physiotherapists

2          ADMINISTRATIVE ARRANGEMENTS
2.1        WHAT DVA PAYS FOR
The Commission will accept financial responsibility for the provision of
physiotherapy services to meet the clinically assessed needs of veterans, provided
the services are delivered in accordance with the guidelines prescribed in the Deed
and the Notes. For information on DVA’s eligibility requirements for veterans,
please refer to section 3 of the Notes.


The Commission DOES NOT PAY for physiotherapy services if the veteran
is NOT ELIGIBLE FOR treatment at Commission expense.



2.2      WHO CAN PROVIDE PHYSIOTHERAPY SERVICES?
The legislation administered by DVA requires that, where a State or Territory has
enacted requirements for registration of health care providers, the provider of the
service must be registered, and be an approved DVA provider at the time of
providing the service.

To gain approval to provide services to veterans, you must:

•       be registered by the relevant Board in the State or Territory where the
        service is provided; or

•       where a State or Territory does not have such legislation, be registered in
        another State or possess qualifications that would permit registration in
        another State; and

•       be a member of, or be eligible for membership in, the Australian
        Physiotherapy Association.

Please note that, where applicable, your State or Territory registration must be
maintained. DVA may seek information to confirm the maintenance of your State
or Territory registration.




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                                Notes for Physiotherapists

2.3       REGISTRATION WITH DVA
All physiotherapists must be individually registered with DVA to provide services
to veterans.


The Commission cannot accept financial responsibility for services provided
by a health care provider who is not registered as a DVA provider.



2.3.1     REGISTRATION PROCESS

When applying for registration as a DVA provider, you are required to complete
and forward all of the following documentation to the DVA State Office for your
State or Territory:

•       Application for Provider Registration (Form D1206); and

•       two copies of the Deed of Agreement

When completing the two copies of the Deed of Agreement, please be sure to
include your address along with your name. This address will be the nominated
address for notices forwarded to you from the Commission. Your practice
address/es, if more than one, or different to the nominated address, should be
included on the Application for Provider Registration (Form D1206).

You must also forward to the DVA State Office for your State or Territory your
proof of registration in the State or Territory in which you practice. If registration
of your field of practice is not required in the State or Territory in which you
practice, please provide proof of your registration in another State or Territory
and/or your qualifications.

You will be notified by letter of the outcome of your application. If you meet
DVA’s requirements and are approved as a provider, you will enter into a Deed of
Agreement with the Commission. The second copy of the Deed of Agreement
will be returned to you for your records. Your provider details, including your
provider number, will be entered on to DVA’s register. Your provider number
uniquely identifies you in DVA’s monitoring and payment systems.

If you work at more than one practice location, you will require a provider
number for each location.

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                               Notes for Physiotherapists
2.3.2    USE OF LOCUMS

If you employ a locum who will be providing services to veterans, DVA expects
the locum to be a registered DVA provider or to apply for provider registration as
quickly as possible.

It is your responsibility to ensure that a locum is aware of DVA’s administrative
arrangements and treatment guidelines.


2.3.3    NO OBLIGATION ON DVA

In agreeing to register as a DVA provider, you acknowledge that there is no
obligation on DVA or the Commission to refer veterans to you. That is,
registering as a DVA provider does not carry with it the assurance that DVA or
the Commission will utilise your services.


2.3.4    WITHDRAWAL FROM CONTRACTUAL ARRANGEMENT
         WITH DVA

If you wish to discontinue providing physiotherapy services to veterans, or cannot
comply with DVA requirements, you must notify the DVA State Office for your
State or Territory of this in writing.


2.4      TRANSFER OF VETERANS

2.4.1    TRANSFER OF YOUR VETERANS

If you decide to resign as a provider, move from an area or cease practice, your
veterans must be referred to another physiotherapist. All of your veterans must be
notified prior to being transferred.

A separate referral is required for each veteran. The referral must be in writing,
on DVA’s Request/Referral Form (Form D904) or official letterhead.

If you transfer to another practice location within an area, you must ascertain
whether or not a veteran wishes to continue seeing you at the new practice
location. If a veteran does not wish to attend the new practice location, you must
refer him/her to another physiotherapist as described above.


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                                 Notes for Physiotherapists
2.4.2      TRANSFER OF VETERANS TO YOU

If a veteran is referred to you by another physiotherapist, you must:

•       contact the DVA State Office for your State or Territory and inform them of
        the transfer; and

•       advise the veteran’s LMO of the transfer and discuss his/her case.


2.5        FEES
Payment for services is based on DVA’s Schedule of Fees for physiotherapy
which is listed at Appendix C. A fee is set for each item number listed in the
Schedule of Fees for physiotherapy. For the item numbers that have a set
maximum fee, the provider claims up to the maximum fee for:

•       the total cost of the service/s delivered as a part of lymphoedema treatment;

•       the actual cost of the pool pass or the individual pool attendances for the
        veteran; or

•       the invoiced cost of the aid prescribed.

The Commission’s financial responsibility for the physiotherapy services that you
provide to veterans, on behalf of the Commission, is limited to the actual fees set
out in the Schedule of Fees for physiotherapy.

DVA increases the fees in the Schedule of Fees for physiotherapy in accordance
with movements in the Consumer Price Index. Any such increase is implemented
from 1 January each year.


You may not make a separate charge on a veteran.




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                               Notes for Physiotherapists

2.6      ACCOUNTS
The processing of DVA claims for payment for physiotherapy services is
undertaken by the Health Insurance Commission (HIC). Full details of account
paying procedures and HIC contact numbers and addresses are listed at Appendix
A.


If you close a practice or change your practice address, you must notify the
HIC and the DVA State Office for your State or Territory.



2.6.1    GROUP PRACTICES

For members of a group practice, provider numbers can be ‘group-linked’, which
allows accounts to be paid to the practice’s principal member or a company, if
required. The practice’s principal member or employer must forward a written
request to be ‘group-linked’ to the DVA State Office for your State or Territory.


2.6.2    ACCOUNTS FOR SERVICES RENDERED BY A LOCUM

If you employ a locum who has a provider number, that number should be used as
the ‘service provider number’ on the account, and your provider number given as
the ‘payee’ provider.

If the locum does not have a provider number, in the short term your provider
number or the ‘group-linked’ number should be used for the payment of accounts.
The account must identify that the service was rendered by a locum. DVA
expects the locum to apply for registration as a DVA provider as quickly as
possible.

2.7      STANDARDS OF CARE

2.7.1    PROFESSIONAL AND ETHICAL STANDARDS

Physiotherapists must meet the professional and ethical standards set by the
Australian Physiotherapy Association, regardless of membership in the
association. It is your responsibility to obtain a copy of the relevant professional
and ethical standards.


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                               Notes for Physiotherapists
2.7.2    CONTINUING EDUCATION

DVA encourages physiotherapists to meet the continuing education requirement
set by the Australian Physiotherapy Association, regardless of membership in the
association. Please retain the documentation to prove that you have met the
continuing education requirement of the Australian Physiotherapy Association.


2.8       DISCHARGE PLANNING
DVA provides Discharge Planning Kits to every public and private hospital and
day facility in Australia. The kit is designed to facilitate effective discharge
planning, and contains a detailed list of all DVA funded services. When a veteran
is discharged from hospital, the treating doctor or the hospital’s discharge planner
may, if necessary, arrange for you to provide physiotherapy services. These
arrangements must include a written referral from the treating doctor in hospital or
the hospital discharge planner on DVA’s Request/Referral Form (Form D904) or
official letterhead.


2.9       NON-COMPLIANCE
While physiotherapy services delivered to veterans are generally appropriate
and of a high standard, please be aware that if you do not comply with DVA
requirements:

(i)     payment of your accounts could be withheld; and/or

(ii)    DVA may determine the type and amount of services you are to provide;
        and/or

(iii) your Deed of Agreement could be terminated, resulting in your removal
      from the DVA register.

DVA may initiate action to recover monies if it is found that there has been
inappropriate servicing or treatment, and may initiate a civil or criminal
prosecution if there is evidence of fraud.

DVA may also disclose relevant information, including information about
inappropriate servicing or treatment, or other professional misconduct, to your
State or Territory Registration Board or the Australian Physiotherapy Association.



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                              Notes for Physiotherapists

3       ELIGIBILITY FOR TREATMENT
3.1     ELIGIBILITY
Veterans who have been issued with a Repatriation Health Card are eligible for a
range of health care services. Card colour determines eligibility for physiotherapy
services.


Treatment, regardless of eligibility, must be based on clinical need.



3.2     REPATRIATION HEALTH CARDS

        GOLD card
                                            Eligibility for physiotherapy services
                                            is based on clinical need




        WHITE card
                                            DVA issues this card to veterans
                                            whose treatment eligibility is limited
                                            to:
                                            • accepted disabilities (conditions
                                                accepted by the Commission as
                                                war caused); and/or
                                            • malignant neoplasia, pulmonary
                                                tuberculosis and post traumatic
                                                stress disorder, where DVA has
                                                accepted responsibility for the
                                                treatment of these conditions




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                               Notes for Physiotherapists
All Repatriation Health Cards must be current, as indicated by the expiry date, for
the veteran to be eligible for services. Other cards that contain a DVA logo, such
as a Pensioner Concession Card, do not make veterans eligible for health care
services.

Spouses and dependants of living veterans are generally not eligible for treatment
under DVA arrangements. Some spouses and dependants of living veterans may
be eligible because of their own war or defence service, and will have their own
Repatriation Health Card.

You must contact the DVA State Office for your State or Territory to check
the eligibility of a White Card holder prior to commencing treatment.


You are responsible for ensuring that a veteran is eligible for treatment. The
Commission will not accept financial responsibility for treatment that you
provide to a veteran who is not eligible to treatment at Commission expense.



3.3      ALLIED VETERANS RESIDENT IN AUSTRALIA
DVA acts as an agent for certain countries whose veterans reside in Australia.
These veterans hold a White Card with limited eligibility for treatment. Subject to
decisions by the relevant government departments of these countries, allied
veterans may be treated for conditions accepted by their country as related to their
war service. Please note that allied veterans are not automatically eligible for
treatment for malignant neoplasia, pulmonary tuberculosis or post traumatic
stress disorder.




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                                    Notes for Physiotherapists

4.         TREATMENT GUIDELINES
4.1        REFERRAL
A referral is required for you to deliver physiotherapy services to a veteran. The
referral can come from:

•       an LMO;

•       a general practitioner;

•       a medical specialist;

•       another physiotherapist with a current referral;

•       a hospital discharge planner; or

•       a treating doctor in a hospital.

The referral must be written on either a DVA Request/Referral Form (Form
D904) or official letterhead. If the referral is written on official letterhead, it must
include:

•       the name of the veteran to whom the services will be provided;

•       the DVA file number of the veteran;

•       the referrer’s provider number;

•       the date of referral; and

•       the condition to be treated (for White Card holders only).

DVA requires the referral to be forwarded to the HIC with your first claim for
payment.




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                                 Notes for Physiotherapists
The referral remains active for six months. However, more than one referral for
physiotherapy services cannot be active at the same time. You should ask the
veteran if they have received another referral for physiotherapy services in the six
months prior to your date of referral. If another referral has been previously
provided, or you have received a referral from another physiotherapist, please
contact the DVA State Office for your State or Territory.


4.2        PATIENT CARE PLAN
A patient care plan is required for each veteran. The patient care plan is
structured by the individual provider. It must include, as a minimum, the
following information:

•       the diagnosis of the condition(s);

•       the planned treatment regime, including the
        i) type,
        ii) number,
        iii)frequency, and
        iv) duration of treatments;

•       the aids and appliances required; and

•       the expected outcomes or results of the treatment regime for the veteran.

The patient care plan must be started at the initial consultation and updated after
each treatment provided to the veteran. Initial consultation fees are not payable
for the on-going maintenance of care plans.

The original patient care plan is to be kept on file at your practice location for five
years. A copy of the patient care plan must be forwarded to the veteran’s LMO,
as the coordinator of the veteran’s health care. You must provide the LMO with
updates of the patient care plan, particularly if there is a change in the veteran’s
condition, or a new condition arises. Do not forward a copy of the patient care
plan to DVA unless you are specifically requested to do so by DVA.




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                                Notes for Physiotherapists

4.3       TREATMENT LIMITS

You determine the type, number and frequency of services to be provided to the
veteran for all of the services that do not require prior financial authorisation from
DVA. This is also the case for the treatment of lymphoedema, once you have
gained prior financial authorisation from DVA. Your determination must be
based on the veteran’s clinical needs.


4.3.1     EXTENDED CONSULTATION

When treating the clinical needs of a veteran, you are able to claim for an
extended consultation, rather then a standard consultation, under certain
circumstances. The circumstances under which you are able to claim for an
extended consultation are as follows:

•       for treatment of two acute and unrelated areas;

•       for treatment of an acute condition when a chronic condition needs ongoing
        treatment; or

•       for treatment of a complex condition which takes in excess of 30 minutes.

Treatment of related areas, or treatment of multiple, chronic musculo-skeletal
conditions, should not be claimed as an extended consultation.


4.3.2 HYDROTHERAPY

A physiotherapist can provide supervised individual or group hydrotherapy, or
unsupervised hydrotherapy, to meet a veteran’s clinical needs as a part of a
normal course of treatment. The supervised individual or group hydrotherapy
cannot be provided by a physiotherapy aide or assistant. The group size for
supervised group hydrotherapy must be appropriate, to ensure that the
physiotherapist is able to meet the clinical needs of the veteran.

Supervised individual hydrotherapy and supervised group hydrotherapy have a set
fee. The fee covers the provision of the service to one veteran. The cost of pool
admission for the veteran is included in the fee, and you are responsible for
organising all aspects of the pool admission.



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                                 Notes for Physiotherapists
The fee for unsupervised hydrotherapy is a set fee for pool visits and a maximum
fee for pool passes. The fees cover the pool admission for one veteran. You are
responsible for organising all aspects of the pool admission, and may choose
which form of pool admission that you wish to use, as appropriate to meet the
clinical needs of the veteran. Please note that if a pool pass is purchased, the pool
pass must only cover the cost of the pool admission, not other services which are
also available from some facilities (eg. access to the gymnasium).

You should claim the actual cost of the pool pass up to the maximum fee. You
must retain all of the receipts and invoices from the purchase of pool passes.

DVA expects you to evaluate the outcomes of the unsupervised hydrotherapy at a
minimum of every six months. A pool pass should not be purchased for more
than a six month period.

The Commission will not accept financial responsibility for the costs associated
with water exercises, water aerobics or recreational swimming.


The cost of pool admission must never be charged to the veteran.



4.3.3      GYMNASIUM PROGRAMS

The Commission will not accept financial responsibility for the costs associated
with veterans attending gymnasiums, including gym memberships.


4.4        PRIOR FINANCIAL AUTHORISATION

4.4.1      WHEN IS PRIOR FINANCIAL AUTHORISATION REQUIRED?

The requirement to obtain prior financial authorisation from DVA has been
removed from the majority of services. The requirement remains in the following
instances:

(i)     treatment is to be provided to a resident of a nursing home;

(ii)    treatment is to be provided to an inpatient in a public hospital; and

(iii) treatment for lymphoedema is to be provided.

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                                    Notes for Physiotherapists
The actual item numbers which retain prior financial authorisation are marked in
DVA’s Schedule of Fees for physiotherapy listed at Appendix C.


4.4.2    HOW IS PRIOR FINANCIAL AUTHORISATION OBTAINED?

You request prior financial authorisation from DVA by forwarding a written
request on the Physiotherapy - Prior Approval Request (Form D990) or official
letterhead to the DVA State Office for your State or Territory. If the written
request is on official letterhead it must include:

•       the name of the veteran for whom you are requesting to provide services;

•       the DVA file number of the veteran;

•       your provider number;

•       the provider number of the referrer;

•       the date of referral; and

•       clinical justification for the requested service.

If you are requesting prior financial authorisation from DVA for lymphoedema
treatment, you must attach proof of your training to the written request. Only
physiotherapists with appropriate training in the treatment of lymphoedema are
able to provide this treatment to veterans.

Your request for prior financial authorisation from DVA will not be automatically
accepted. If the request is approved, authorisation will be given:

(i)     for a set number of services for treatment in a nursing home or public
        hospital; and

(ii)    to provide treatment for lymphoedema.

This authorisation will be forwarded to you in writing.

For the treatment of lymphoedema, the physiotherapist, upon receiving prior
financial authorisation from DVA, will determine the type, number and frequency
of services to be provided to the veteran. The physiotherapist should claim for the


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                               Notes for Physiotherapists
total cost of the services provided up to the maximum fee. The total cost can be
claimed progressively.


The Commission will NOT PAY for services where prior financial
authorisation was required from DVA but not obtained.



4.5       MONITORING
DVA has systems to monitor the servicing patterns of its contracted health care
providers. These systems are used to identify providers who may be providing
inappropriate levels or types of services. If DVA considers that you may be
servicing inappropriately, you will be contacted and asked to provide
documentation to justify that the services are appropriate to meet the veteran’s
clinical needs. A Departmental officer may ask to attend your practice location
and view the documentation there.


4.6       AUDITING
DVA may conduct compliance audits of service providers. The audits will
identify whether a service provider is complying with:

•       DVA’s administrative arrangements; and

•       DVA’s treatment guidelines.

The compliance audits will be conducted at the service provider’s practice
location. The service provider will be given advance written notification of the
audit.




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                                 Notes for Physiotherapists

4.7        TRAVEL EXPENSES
The Commission will only pay for your travel expenses if you are required to
attend a veteran at home, at a public hospital, at a private hospital, hostel or
nursing home and:

•       the travel takes place outside a metropolitan area and exceeds ten
        kilometres; or

•       the travel takes place in a metropolitan area and exceeds ten kilometres,
        and there is a scarcity of physiotherapists in the city such that the nearest
        suitable physiotherapist is unable to attend the veteran.

Travel expenses are paid for each kilometre after the first ten kilometres.
However, you must state the full distance travelled on the claim voucher. The
first ten kilometres will be deducted before the amount owed is calculated.


4.8        HOME VISITS
You may provide treatment in a veteran’s home when there is a genuine need to
do so. A genuine need includes when the veteran is bedridden or non-ambulatory
and does not have access to transport.


4.9        NURSING HOME VISITS
The Commission will not accept financial responsibility for maintenance services
provided to residents of nursing homes. These services are defined as care
designed to maintain the resident’s level of independence and standard of health.
This physiotherapy treatment is the financial responsibility of the nursing home
and they receive government funding accordingly.

The Commission will consider payment for intensive, long-term services required
following a serious illness or injury, surgery or trauma, however prior financial
authorisation is required.

Physiotherapy services carried out in nursing homes will only be approved in
exceptional circumstances.




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                                  Notes for Physiotherapists

4.10       PUBLIC HOSPITAL VISITS
Services for veterans in public hospitals are funded directly by the State
Governments through the current agreements between the State and
Commonwealth Governments. It is the responsibility of the public hospital to
arrange and fund services for veterans attending as inpatients.

Physiotherapy services carried out in public hospitals will only be approved
in exceptional circumstances.


4.11       ADVICE FROM DVA
Please contact the DVA State Office for your State or Territory if you require:

•       clarification of DVA’s administrative arrangements;

•       clarification of DVA’s treatment guidelines;

•       information on a veteran’s eligibility; and/or

•       expert clinical advice.

4.11.1 DVA STATE OFFICE CONTACT LIST
New South Wales and                            South Australia and
Australian Capital Territory                   Northern Territory
GPO Box 3994                                   GPO Box 1652
SYDNEY 1141                                    ADELAIDE 5001
Telephone: (02) 9213 7017                      Telephone: (08) 8290 0381

Victoria                                       Western Australia
GPO Box 87A                                    GPO Box F352
MELBOURNE 3001                                 PERTH 6001
Telephone: (03) 9284 6000                      Telephone: (08) 9366 8373

Queensland                                     Tasmania
GPO Box 651                                    GPO Box 481E
BRISBANE 4001                                  HOBART 7001
Telephone: (07) 3223 8333                      Telephone: (03) 6221 6650



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                                  Notes for Physiotherapists

4.12       AIDS AND APPLIANCES


The prescription of aids and appliances must be based on clinical need.


4.12.1 ELIGIBILITY FOR AIDS AND APPLIANCES

        GOLD card holders are eligible for a wide range of aids and appliances.

        WHITE card holders are eligible if the aid or appliance is for a condition
        accepted by DVA.


4.12.2     PH91 (PHYSIOTHERAPY TREATMENT AIDS)

You can prescribe an aid to meet a veteran’s clinical need without prior financial
authorisation from DVA, if the cost of the aid is $150 or lower. You should claim
the invoiced cost of the aid under item number PH91 (Physiotherapy Treatment
Aids). You should retain the invoices for all of the aids that you prescribe under
PH91.

If an aid costs in excess of $150, the aid must be prescribed through DVA’s
Rehabilitation Appliances Program (RAP).


4.12.3     REHABILITATION APPLIANCES PROGRAM (RAP)

The Rehabilitation Appliances Program (RAP) aims at restoring, facilitating or
maintaining functional independence and minimising a veteran’s disability or
dysfunction.


4.12.4     PRESCRIBING AIDS AND APPLIANCES UNDER RAP

Physiotherapists are listed as prescribers under RAP for certain aids and
appliances. These aids and appliances can be obtained under contractual supply
arrangements established by DVA. Please contact the DVA State Office for your
State or Territory:

•       to obtain a list of the aids and appliances that you are able to prescribe;


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                                 Notes for Physiotherapists
•       to obtain prior financial authorisation before prescribing aids and
        appliances; and/or

•       to determine payment arrangements for the supply of aids and appliances.


4.12.5 PRESCRIBER RESPONSIBILITY

As a prescriber, the Commission relies on you to:

•       ensure the safety, suitability and appropriateness of prescribed aids and
        appliances;

•       educate the veteran on the use of the prescribed aid or appliance; and

•       gain prior financial authorisation from DVA if it is required.




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                                 Notes for Physiotherapists

5         TERMS AND CONDITIONS OF
          REGISTRATION AS A HEALTH PROVIDER
          WITH DVA
5.1       DEFINITIONS/GLOSSARY
In these Notes, unless the contrary intention appears:

"Act" means the Veterans' Entitlements Act 1986;

"Application" means the form of application for entry on the Register completed
and submitted to the Department by the Provider;

"Veteran(s)" means veterans, war widows, dependants of veterans and other
persons referred to in paragraph 180 (1) (c) of the Act;

"Document" includes:

(a)     any paper or other material on which there is writing;

(b)     any paper or other material on which there are marks, figures, symbols or
        perforations having meaning for persons qualified to interpret them;

(c)     any article or material from which sounds, images or writing are capable of
        being reproduced with or without the aid of any other article or device;

"Health services" means the physiotherapy treatment and other services that the
Provider agrees to provide in accordance with the Act and under the Terms and
Conditions in the Deed and these Notes;

"Notes" means these Notes for Physiotherapists including the Terms and
Conditions in Section 5, issued by the Department, and amended from time to
time;

"Register" means the register, maintained by the Department, of providers of
Health Services for Veterans;

"Secretary" means the Secretary to the Department or a person authorised by the
Secretary in writing for the purposes of the Deed and these Notes;




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                                Notes for Physiotherapists
"Working Day" in relation to the doing of an action in a place, means any day
other than a Saturday, Sunday or public holiday in that place.


5.2       PRECEDENCE
In the event of an inconsistency arising between a provision of the Deed and these
Notes and a provision of another agreement between the same parties, the
provision of the Deed and these Notes shall prevail to the extent of the
inconsistency.


5.3       QUANTITY OF BUSINESS
The Provider acknowledges that there is no obligation on the Commonwealth or
the Repatriation Commission to provide him or her with any quantity of business.
That is, becoming a DVA provider does not carry with it an expectation that the
provider’s services will necessarily be utilised.


5.4       PROVISION OF HEALTH SERVICES AND PAYMENT
The Provider shall provide for a veteran or veterans on request by or on behalf of
the Commonwealth the health services described in the request.

Subject to the Deed and these Notes, the Commonwealth shall pay the provider
for health services provided for veterans by the provider.


5.5       PROVIDER QUALIFICATIONS
A DVA physiotherapy provider must:

•       be a qualified physiotherapy practitioner registered or licensed in
        accordance with the laws of the State or Territory in which the provider’s
        practice is located; and

•       agree to provide health services in accordance with the terms and conditions
        set out in the Deed and these Notes.




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                                 Notes for Physiotherapists

5.6        QUALITY OF HEALTH SERVICES
The provider shall ensure that any health services provided by the provider under
the Deed are in accordance with the Act and the standards and ethics accepted by
the Australian Physiotherapy Association as appropriate for those it represents and
meet the requirements of the Deed and these Notes.


5.7        INAPPROPRIATE SERVICING
This can involve ‘overservicing’, ‘underservicing’ and fraud. ‘Overservicing’ can
be defined as a provider performing and billing the Commission for more services
or more extensive/expensive services than can be justified on clinical grounds.
‘Underservicing’ can be defined as a provider performing a lower number of
services than clinically required. Although this standard of service results in
lower expenditure for DVA, it is contrary to the goals of the Department and the
Commission and is counter to our objective of providing veterans with quality
health services.

The Commission reserves the right to determine the level of servicing for veterans
for which it will accept financial responsibility.

A veteran may sometimes ask you to provide services that are not reasonably
necessary. The Repatriation Commission will not accept financial responsibility
for these services.

DVA’s computerised payment system can monitor the types and number of
services provided by all health care providers. If, in the opinion of the
Commission, you are providing inappropriate levels or types of service, DVA will
inform you of these concerns in writing. You will be given sufficient time to
rectify the matter before DVA takes further action. Should this inappropriate
servicing continue, the Commission may:

•       terminate your registration as a DVA provider;

•       recover any relevant payments made to you; and

•       disclose any relevant information to the State or Territory registration board
        and/or the Australian Physiotherapy Association.




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                              Notes for Physiotherapists
Penalties of up to $10,000, or imprisonment for up to five years, or both, may be
imposed on any person who is convicted of making a false claim on the
Commission in relation to treatment services.

The Commission has the statutory authority to obtain information from health care
providers and other persons about the medical condition and treatment of
individual veterans. If you disclose such information to the Commission, you are
protected under the Veterans’ Entitlements Act 1986 from any possible action by a
beneficiary for breach of confidence.


5.8     AMENDMENT OF NOTES
The Notes may be amended from time to time by the Commonwealth.

The Commonwealth shall consult with the Australian Physiotherapy Association
before amending any of the following provisions of the Notes, namely Sections 2,
4 and 5 and Appendix C.

The Commonwealth undertakes to use its best endeavours to notify the provider
of amendments to the Notes in advance of those amendments taking effect.


5.9     RIGHT OF COMMONWEALTH TO RECOVER
        MONEY
Without limiting the Commonwealth’s rights under any provision of the Deed and
these Notes, any payment or debt owed by the provider to the Commonwealth
under the Deed and these Notes may be deducted by the Commonwealth from the
amount of payment of any claim or from any other monies payable to the provider
by the Commonwealth under the Deed and these Notes.

Where the Commonwealth deducts the amount of a debt or payment, it shall
advise the provider in writing that it has done so.


5.10    SUBCONTRACTING
The provider shall not, without first obtaining any approval required by the Deed
and these Notes, subcontract the performance of any part of the health services.



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                                 Notes for Physiotherapists
The provider shall be fully responsible for the performance of the health services
notwithstanding that the provider has subcontracted the performance of any part
of those services.

Despite any approval given by the Commonwealth, the provider shall be
responsible for ensuring the suitability of a subcontractor for the work proposed to
be carried out and for ensuring that such work meets the requirements of the Deed
and these Notes.

The provider shall ensure that a subcontractor is aware of all terms and conditions
of the Deed and these Notes relevant to the subcontractor’s part in the provision of
the health services.

The provider shall pay its subcontractor in accordance with the terms of the
relevant subcontract.


5.11       ACCESS TO DOCUMENTS
The provider shall retain any documents relating to the care of a veteran for at
least five years after providing the health care and shall allow the Commonwealth
access to those documents at all reasonable times for the purpose of examining
and copying them.

The provider shall ensure that their subcontractors similarly retain and allow
Commonwealth access to documents relating to the care of a client.

The provider’s obligations relating to Departmental access to documents shall
survive the termination of the provider’s DVA registration.


5.12       PROTECTION OF PERSONAL INFORMATION
The provider agrees with respect to the health services:

a)      to comply with the Information Privacy Principles set out in section 14 of
        the Privacy Act 1988 that concern the collection, solicitation, security, use
        and disclosure of personal information to the extent that the content of those
        principles apply to the types of activities the provider is undertaking for the
        Commission and the Department, as if it were a record-keeper as defined in
        the Privacy Act 1988.


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                                 Notes for Physiotherapists
b)      to cooperate with the Privacy Commissioner in relation to any reasonable
        demands or inquiries made by the Privacy Commissioner and comply as far
        as practicable with any policy guidelines laid down by the Commonwealth
        or issued by the Privacy Commissioner; and

c)      to comply as far as practicable with any reasonable direction of the
        Commonwealth to observe any recommendation of the Privacy
        Commissioner relating to any acts or practices of the provider that the
        Privacy Commissioner considers breach these obligations.

Without limiting the generality of sub-paragraphs 16.10 a), b) and c), the LMO
shall ensure that any personal information coming into his/her possession in
providing health services is protected, by such security safeguards as it is
considered reasonable in the circumstances to take, against loss, against
unauthorised access, use, modification or disclosure, and against other misuse.

The LMO shall also ensure as far as practicable that his/her subcontractors assume
corresponding obligations in relation to personal information.

The LMO shall indemnify the Commonwealth in respect of

•       any loss, liability or expense suffered or incurred by the Commonwealth
        arising out of or in connection with a breach of the obligations of the LMO
        in regard to records and personal information; or

•    any misuse of personal information or any disclosure by the LMO or his/her
     subcontractor in breach of an obligation of confidence.
This provision shall survive the expiration or termination of the LMO's
appointment.

Freedom of information under the Freedom of Information Act 1982

Without limiting the generality of Section 5.12, the Provider shall ensure that any
personal information coming into its possession in providing the health services is
protected, by such security safeguards as it is reasonable in the circumstances to
take, against loss, against unauthorised access, use, modification or disclosure,
and against other misuse.

The provider ensures as far as practicable that its subcontractors assume
corresponding obligations in relation to personal information.




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                               Notes for Physiotherapists
The provider shall indemnify the Commonwealth in respect of any loss, liability
or expense suffered or incurred by the Commonwealth arising out of or in
connection with a breach of the obligation of the provider under this Section 5.12
or any misuse of personal information by the provider or its subcontractor or any
disclosure by the provider or its subcontractor in breach of an obligation of
confidence. This provision shall survive the expiration of termination of the
Deed.

In this Section 5.12, ‘personal information’ has the same meaning as in the
Privacy Act 1988.


5.13     INSURANCE AND INDEMNITY
The provider shall at all times indemnify and hold harmless the Commonwealth
and the Repatriation Commission, their officers, employees and agents (in this
paragraph referred to as, "those indemnified") from and against any loss
(including legal costs and expenses on a solicitor/own client basis), or liability,
incurred or suffered by any of those indemnified arising from any claim suit,
demand, action, or proceeding by any person against any of those indemnified
where such loss or liability was caused by any wilful unlawful or negligent act or
omission by yourself, your officers, employees or agents in connection with this
contract or in the course of, or incidental to, performing the health services.

The provider’s liability to indemnify the Commonwealth and the Repatriation
Commission under the previous paragraph shall be reduced proportionally to the
extent that any act or omission of the Commonwealth, the Repatriation
Commission or their officers, employees or agents contribute to the loss or
liability.

The indemnity referred to in this Section 5.13 shall survive the expiration or
termination of DVA registration.

The provider shall, for so long as any obligations remain in connection with the
provider’s DVA registration, effect and maintain adequate professional indemnity
and public liability insurance.

Wherever requested, the provider shall provide the Commonwealth with a copy of
any insurance policy and a certificate of currency.




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                                  Notes for Physiotherapists

5.14       NEGATION OF EMPLOYMENT AND PARTNERSHIP

The provider:

(a)     is not by virtue of the Deed;

(b)     shall not represent itself to be; and

(c)     shall ensure that none of its partners, employees, agents or subcontractors
        represents himself, herself or itself to be;

an employee or partner of the Commonwealth or otherwise able to bind or
represent the Commonwealth.


5.15       COMPLIANCE WITH LAWS
The provider shall in providing the health services comply with all applicable
laws.


5.16       LAW APPLYING TO THE DEED OF AGREEMENT
The Deed of Agreement shall be governed by and construed in accordance with
the law in force in the Australian Capital Territory.


5.17       LIABILITY
The liability of a party for breach of the Deed, or in tort, or for any other common
law or statutory cause of action arising out of the operation of the Deed, shall be
determined under the relevant law in Australia that is recognised, and would be
applied, by the High Court of Australia.


5.18       ASSIGNMENT
The provider shall not assign its rights under the Deed.




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                                 Notes for Physiotherapists

5.19       WAIVER
Failure by a party to enforce a provision of the Deed or these Notes shall not be
construed as a waiver of the provision.


5.20       VARIATION
No variation to Sections 5.1 - 5.23 of these Notes shall be binding unless it is in
writing and signed by both parties.


5.21       DISPUTE RESOLUTION
If any dispute arises between the parties in relation to the Deed and these Notes,
the provider and the responsible Director Health of the Department for the State,
Territory or place in which the provider mainly provides health services, shall
attempt to resolve the dispute.

If the Director (Health) and the provider fail to resolve the dispute within ten
working days of the issue arising, the provider and the responsible Deputy
Commissioner of the Department for that State, Territory or place shall attempt to
resolve the dispute.

Failing agreement between the Deputy Commissioner and the provider, the parties
shall seek to agree on a process for resolving the dispute through means other than
litigation or arbitration, such as further negotiations, mediation, conciliation,
independent expert determination or mini-trial and on:

a)      the procedure and timetable for any exchange of documents and other
        information relating to the dispute;

b)      procedural rules and timetable for the conduct of the selected mode of
        proceeding;

c)      a procedure for selection and compensation of any neutral person who may
        be appointed by the parties in dispute; and

d)      whether the parties should seek the assistance of a dispute resolution
        organisation.



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                               Notes for Physiotherapists
The parties acknowledge that any exchange of information or documents or the
making of an offer of settlement in relation to this Section 5.21 is for the purposes
of attempting to settle the dispute between the parties. Neither party may use any
information or documents obtained through the dispute resolution process
established by this clause, for any purpose other than in an attempt to settle a
dispute between them.

If agreement on a process and a timetable cannot be achieved within ten working
days, or the time established for resolution of the dispute has passed without
resolution, any party which has complied with these provisions may, by notice,
terminate the dispute resolution process and, in its absolute discretion, either
institute court proceedings or refer the subject of the dispute to arbitration. Any
arbitration shall be conducted under the laws relating to arbitration for the time
being enforced in the Australian Capital Territory and the parties may have legal
representation in any arbitration conducted.

These dispute resolution provisions shall survive the expiration or termination of
the provider’s registration with the Commission.


5.22      TERMINATION OF DVA REGISTRATION
DVA provider registration will terminate automatically if a provider ceases to be
registered in their field of practice in their State or Territory of practice, or
disposes of or leases his/her practice. Where the Department’s efforts to make
contact with a provider have been unsuccessful at a particular practice address, the
Department will close off that practice address in its DVA provider register and
the provider will need to make contact with the Department to have the practice
address re-opened for the purposes of the DVA register.

Termination will involve removal from the Department’s register of providers
without being given the opportunity or further opportunity to show cause why the
provider should not be removed from the register.

If a provider’s registration is terminated, the Commission will pay for the services
provided up to the date of termination, subject to the paragraphs on inappropriate
servicing in Section 5.7 of these Notes.

A provider’s DVA registration may be terminated:

•       immediately by mutual consent;



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                                  Notes for Physiotherapists
•       immediately in writing by the Commission without notice, and the
        opportunity being given by the Commission to show cause why termination
        should not proceed: if

        (a)   the provider engages in serious or wilful misconduct in performing the
              health services;

        (b)   for any period the provider is not qualified to provide the allied health
              services;

        (c)   the Secretary of the Department believes on reasonable grounds that
              the provider has committed fraud against the Commonwealth;

        (d)   the provider:

              (i)    becomes bankrupt or insolvent;

              (ii)   makes an assignment of his/her estate for the benefit of creditors
                     enters into any arrangements or composition with his/her
                     creditors or has a receiver and manager appointed on behalf of
                     debenture holder or creditors;

              (iii) goes into liquidation or passes a resolution to go into liquidation,
                     otherwise than for the purpose of reconstruction, or becomes
                     subject to any petition or proceedings in a court for its
                     compulsory winding-up; or becomes subject to suervision of a
                     court either voluntarily or otherwise;

        (e)   the provider assigns his/her rights under the agreement with the
              Commission;

        (f)   the provider is removed from the health register in connection with
              any other agreement between the parties;

In such circumstances, the Commonwealth may immediately terminate the
agreement with the provider in writing without giving the provider an opportunity
to show cause why termination and removal from allied health provider register
should not proceed.




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                                 Notes for Physiotherapists
•       immediately by notice in writing, following failure to satisfy the
        Commonwealth, in circumstances where the provider was asked to "show
        cause" why termination should not proceed. This does not prejudice any
        right of action or remedy to which either party may be entitled.

(a)     the provider, in the opinion of the Secretary of the Department

        •     defaults in the performance or observance of any obligation under
              his/her contract with the Department, which includes an obligation to
              perform the health services in accordance with Departmental
              requirements as set out in the Deed and these Notes; or

        •     is convicted of an offence which is punishable by a term of
              imprisonment or pecuniary penalty exceeding $1,000.

In these circumstances, the Commonwealth may call upon the provider by notice
in writing specifying the default or conviction. to show cause within a period
specified in the notice which shall be not less than 20 working days, why his/her
provider status should not be terminated and he/she removed from the
Department’s provider register.


5.23        NOTICES
Any notice, request or other communication relating to the terms and conditions in
these Notes shall be in writing and dealt with as follows:

(a)     if given by the provider to the Commonwealth: addressed and forwarded to
        the Deputy Commissioner in the DVA State Office of the relevant State; and

(b)     if given by the Commonwealth to the provider: except in the case of
        payments, for which a different address is nominated, forwarded to the
        provider at the address for notices nominated by the provider.

Any such notice, request or other communication shall be delivered by hand or
sent by pre-paid security post or facsimile, to the address of the party to which it is
sent and will be deemed to be received:

(a)     if delivered personally, on the date of delivery;

(b)     if sent by pre-paid security post, on the day that the acknowledgment of
        delivery is completed by the recipient; and

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                                Notes for Physiotherapists
(c)     if sent by facsimile, on the working day next following the day of dispatch
        providing that the sender receives an "OK" (or any other relevant code) in
        respect of the transmission is not notified by the recipient by close of
        business of the next working day following the day of dispatch that the
        transmission was illegible.




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        Notes for Physiotherapists




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                Notes for Physiotherapists




                APPENDIX A




        ACCOUNTS PAYMENT PROCEDURES




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        Notes for Physiotherapists




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                              Notes for Physiotherapists

1       THE DVA ACCOUNTS PAYMENT SYSTEM
The processing of DVA claims is undertaken by the Health Insurance
Commission (HIC).


1.1     BACKGROUND
Automated systems process accounts sent by providers treating veterans. This
allows for prompt, accurate payment. Incomplete, inaccurate or illegible
information causes delays. Please use DVA stationery, provided free of charge
from the HIC and designed to ensure that sufficient information is supplied to
process the account promptly. See Page 58 of Appendix A for HIC contact
numbers for ordering DVA stationery.


Imprinting the DVA Repatriation Health Card on DVA stationery minimises
errors when processing accounts.



1.2     PROVIDER REGISTRATION
Providers are issued with plastic identification cards which contain information
used in our payment system. These can be used in supplied imprinters, which can
be requested from the HIC. Cards contain the provider name, practice address and
the provider number used in the payment system to identify the provider at that
location.

If you use more than one practice location, you will be issued with a different
provider number for each location. When you change or obtain another
practice address, a new provider number must be obtained for each new
address. If you submit an account with a new address using a provider
number relating to another practice, the cheque will go to the previous
address.

All changes to practice details must be submitted in writing to the HIC and
the DVA State Office for your State or Territory.




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                                Notes for Physiotherapists

1.3       PAYMENT TO DIFFERENT NAMES AND
          ADDRESSES
DVA has a ‘group link’ facility which allows payments to a name or address
different to the provider card. This allows for:

(i)     payment to a business name at a business address; or, to an agency; or

(ii)    cheques being sent to an address other than the practice address linked to a
        provider number (to a post office box, for example).

When a ‘group link’ is established, the payment name and address is linked to the
provider number in the system to ensure correct crediting.

To apply for a ‘group-link’ facility, your practice’s principal member or employer
must write to the DVA State Office for your State or Territory, with details of the
arrangements you require.


2         BILLING PROCEDURES
2.1       BILLING DVA
To bill for your services, you should complete the relevant service voucher(s)
(Form D1221) and a Claim for Treatment Services (Form D1217). The Form
D1217, together with the relevant service voucher(s) (Form D1221) constitutes
your accounts ‘claim’.

All services in an account must have been rendered by the same provider. The
claim may contain service vouchers of various veterans, so long as the total
number is less than 50. If you submit claims on a regular basis with fewer
vouchers, you will receive regular payments.




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                                Notes for Physiotherapists




                                                             Multiple service vouchers with all
                                   Service                   services by same provider

                                   Voucher
        DVA Claim Form
        (Form D1217)          MULTIPLE SERVICE VOUCHERS


SINGLE CLAIM FORM




2.2        CLAIM FOR TREATMENT SERVICES (FORM D1217)
You must use the Claim for Treatment Services (Form D1217) when claiming. It
is supplied in a carbonised format and is suitable for use in an imprinter. After
completion, attach the relevant service vouchers to your account and send with the
Department copy to the HIC. Keep the claimant copy for your records.

This form has mandatory requirements; failure to complete the form or the
omission of relevant details will result in the entire account being returned to you
unpaid. The claim form must include the service provider’s name and address,
provider number (if known) and the signature of the provider who rendered the
services.

For accurate processing, please also include the following information:

(i)     number of vouchers included in the account; and

(ii)    the date the claim form was signed.




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                                 Notes for Physiotherapists
The Claim for Treatment Services (Form D1217) is as follows:




INSERT CLAIM FOR TREATMENT SERVICES (FORM D1217)




2.3        HEALTH PRACTITIONER SERVICE VOUCHER
           (FORM D1221
The Health Practitioner Service Voucher (Form D1221) details services provided
to veterans. This voucher can be used in an imprinter. Forward the Department
copy to the HIC with a Claim for Treatment Services (Form D1217), keep the
claimant copy for your records and give the veteran the patient copy. When you
are claiming an initial consultation, you should attach the relevant referral on a
Form D904 or official letterhead to the Department copy before lodging it with
the HIC.

The Health Practitioner Service Voucher has mandatory information
requirements:

•       the practitioner’s name, that of the veteran and the consultation date;

•       the service item number and fee claimed (listed at Appendix C); and

•       the condition treated, if the veteran is a White Card holder. If the condition
        treated is not included on the voucher, the claim may be rejected.



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                              Notes for Physiotherapists
Please have the service voucher signed by the veteran for each service, give
the veteran the patient copy of the completed service voucher and keep the
claimant copy for your records, to help any queries. The Department copy is
sent to the HIC.

The Health Practitioner Service Voucher (Form D1221) is as follows:




INSERT HEALTH PRACTITIONER SERVICE VOUCHER (FORM
D1221)




2.4     LODGEMENT OF CLAIMS
Completed claims are lodged with the HIC. For services that require prior
financial authorisation from DVA, you should ensure that the request for prior
financial authorisation is received by DVA at least one week before any
associated claims are submitted to the HIC. This enables DVA to process the
request and, where approved, pass the approval information electronically to the
HIC so that the claims can be paid.

Contact numbers and addresses for the HIC are on page 58 of Appendix A.




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                                 Notes for Physiotherapists

2.5        REQUIRED TIMEFRAME FOR THE LODGEMENT OF
           CLAIMS

You are required to lodge claims for payment within six months of the date of
service. A longer period may be allowed in certain circumstances. If you believe
that your circumstances warrant a longer period, please contact the DVA State
Office for your State or Territory.


2.6        FOR FASTER PROCESSING

•       use the veteran’s Repatriation Health Card and a supplied imprinter;

•       make sure that the complete name is used. If you need to write the veteran’s
        details on a claim, wherever possible copy the patient name and file number
        details directly from the veteran’s Repatriation Health Card. If you do not
        have the card, ensure that the complete name is used. For example, a
        preferred name of Jack instead of John should not be used;

•       use DVA stationery;

•       include the provider name and number;

•       complete the mandatory information requirements;

•       ensure legibility and correctness.


3          RECEIVING PAYMENT
When the HIC pays a claim for payment, a cheque goes to the payee provider
detailing all services that have been paid. The statement also shows:

•       a code and explanation if the HIC, on behalf of DVA, has declined to pay;

•       whether the amount paid differs from that claimed;

•       the veteran’s DVA file number (if altered or not supplied); and

•       the telephone number for any queries.



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                                   Notes for Physiotherapists
An example of a completed statement is on the next page.


                 Commonwealth Department
                 of                                        Statement of Benefit
                 Veterans' Affairs
                                                      PHONE          1300 550 051
                                                      DATE           191099
_____                           6 222                 RUN            277
                 MS W R WHEATIN                       PROVIDER       0031350X
                 47 RAYMOND CRES
                 CAMBERWELL VIC
                 3124
                                                                                12819634
PATIENT NAME     FILE NO     LOC     DATE             NO    ITEM      CLAIMED    PAYABLE     E XP
                 TO


CLAIM NO :
X6914

CLEARY, ANNA     VX97491A              270899              PH20        31.65         31.65

EVANS, JOYCE     VX156772A             140999              PH20        31.65         0.00    162

WOOD, ERIC H     VX233830              270999              PH10        39.40         39.40

                 TOTAL FOR CLAIM NO:    X 6914                     $102.70       $71.05

                            TOTAL CHEQU               AMOUNT                    $71.05
                 E



EXPLANATION OF CODES

          162 SERVICE HAS BEEN PREVIOUSLY PAID
-------------------------------------------------------------------------------------

THE ACTUAL CHEQUE IS ATTACHED HERE




If more than one claim is paid on a cheque, service details for each claim will be
listed separately.

Large claims will have a summary with the cheque; a statement will follow later.



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                                             Notes for Physiotherapists
A summary statement looks like this:

                Commonwealth Department of
                Veterans' Affairs                              Statement of Benefit
                                                         PHONE                1300 550 051
                                                         DATE                 160999
                                              0 333      RUN                  281
___         MR M W CUTTAR                                PROVIDER             0735150X
            29 ROADE AVE
            OAKLEIGH VIC 3166

                                                                                  12814324
-------------------------------------------------------------------------------
------------
THE CLAIMS LINKED WITH THIS CHEQUE ARE SUMMARISED BELOW. A DETAILED STATEMENT
IS FORWARDED SEPARATELY.

CLAIM NO : X6914


                                 Claim No:                Amount                     Amount Paid:
                                 Claimed:                                               $2970.60
                                     X6914                 $3002.00


                         T O T A L C H E Q U E AMOUNT:                                $2970.60
-------------------------------------------------------------------------------

THE ACTUAL CHEQUE IS ATTACHED HERE



4           PAYMENT PROBLEMS

4.1         NON-PAYMENT OF CLAIMS
Sometimes a claim will not be paid by the HIC. Reasons for this include:

•       the claim form is unsigned by the provider;

•       the servicing or payee provider is not identified;

•       prior financial authorisation was required from DVA but not sought;

•       the service voucher is unsigned by the veteran;



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                                 Notes for Physiotherapists
•       information needed to pay the claim has been omitted on the service
        voucher (eg. date of service, patient name or DVA file number);

•       the information is incorrect (eg. item numbers, veteran’s details); or

•       no item number or description of the service is provided.

Where appropriate, the entire claim or a number of service vouchers are returned
to the provider with an explanation of non-acceptance. The claim or vouchers
may be re-lodged with the HIC when amended.

The HIC, on behalf of DVA, has a 28 day maximum goal for the payment of all
claims. Please do not contact the HIC with queries relating to unpaid claims until
at least the 21st day after you have lodged your claim.


4.2        RELODGEMENT OF CLAIMS
If an entire claim is returned to you for reasons listed in Section 4.1, please re-
lodge it with the HIC as a whole with a new Form D1217. If a single voucher or
number of vouchers is declined and returned, the information needs amending.
These voucher(s) can be re-lodged with the next claim.


4.3        ADJUSTMENTS
An adjustment may be required if an incorrect payment has been made. Requests
for adjustments should be made in writing to the HIC, and the following
information must be supplied:
•       the reason for the adjustment;
•       the provider number;
•       the claim number of the original claim (pre-numbered by HIC); and
•       details of the veteran involved.
Please do not lodge your copy of a service voucher or claim form with the HIC for
an adjustment. In unusual circumstances, (such as when an entire account is lost
in transit), it may be necessary to send your copies to the HIC. If this happens, it
would assist the HIC if you attached a letter explaining why the account is being
re-lodged.


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                                 Notes for Physiotherapists

5          INQUIRIES
For inquiries about payment matters, please have the following information ready
when contacting the HIC:

•       provider number and claim number (on Form D1217); and

•       service voucher details: service date; patient’s name; file number;

This assists the process, ensuring that the response is both accurate and complete.

6          CONTACT NUMBERS AND ADDRESSES FOR THE
           HIC
Where to Send Claims:                 Health Insurance Commission
                                      GPO Box 964
                                      ADELAIDE SA 5001
Claim Inquiries:                1300 550 051
Claim Stationery:

DVA’s claim stationery is available through Leigh-Mardon Pty Ltd. Orders for
claims stationery should be mailed to:

Health Insurance Commission
Locked Bag 4444
TUGGERANONG ACT 2901

Urgent orders can be faxed to:        (02) 6230 0477

Inquiries about stationery orders should be directed to Leigh-Mardon Pty Ltd on:
1800 067 307

Please note that all stationery orders must be in writing.

Imprinters:

Imprinters for use with DVA stationary are available from the HIC by
telephoning: 132 150




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              Notes for Physiotherapists




              APPENDIX B




        REPATRIATION TRANSPORT




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        Notes for Physiotherapists




10/99              58
                               Notes for Physiotherapists

REPATRIATION TRANSPORT

1        INTRODUCTION
This appendix describes the arrangements and conditions for veterans to obtain
travel assistance under the Repatriation Transport Scheme.


2        REPATRIATION TRANSPORT SCHEME
The Commission may pay travelling expenses for a veteran to attend the closest
practicable health provider to the veteran’s home. The veteran must travel by the
most economical and suitable means of transport available at the time.

Transport arrangements will generally be made by the veteran. However, in
certain circumstances, transport may be arranged for the veteran by DVA. A
veteran who has incurred expenses in relation to their travel for treatment needs to
submit a claim to DVA to seek reimbursement.


3        ELIGIBILITY FOR TRAVEL ASSISTANCE
Veterans are eligible for travel assistance for treatment in accordance with their
Repatriation Health Card. Travel assistance is available to Gold Card holders for
treatment of all conditions, and to White Card holders for treatment of accepted
disabilities only.


4        ACCEPTABLE MEANS OF TRAVEL

The Department will assist veterans with travelling expenses for the use of private
vehicles or public transport. If either of these modes of transport are not available
or are medically unsuitable, veterans may be able to travel by taxi, community
transport, ambulance or air, at the Department’s expense.




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                                 Notes for Physiotherapists

5          CLAIMS BY VETERANS FOR REIMBURSEMENT OF
           TRAVELLING EXPENSES
To claim for reimbursement of travelling expenses incurred in relation to
treatment, a veteran must complete a Claim for Travelling Expenses form (D800).
To claim for travelling expenses incurred in relation to an Administrative Appeals
Tribunal (AAT) or a Veterans’ Review Board (VRB) claim, a veteran must
complete an Application for Travelling Expenses in Connection with a Medical
Review form (D803).

The claim must be lodged with the DVA State Office for the State or Territory in
which the travel was undertaken, within three months of the date of the first health
provider visit claimed.


6          PROVIDER CERTIFICATION
Treating health providers must endorse on the relevant section of the Claim for
Travelling Expenses (D800) form that they are the closest practicable health
provider to the veterans home. If a veteran obtains treatment from a health
provider who is more than 50 kilometres from the veteran’s home, and the health
provider has not indicated on the form that he or she is the closest practicable
health provider, the Department will pay travelling expenses only for the first 100
kilometres travelled for that visit.


7          TAXI TRANSPORT
A veteran may travel by taxi for treatment purposes only if the health provider
certifies that it is medically essential and that the veteran cannot use public
transport or a private vehicle because of one of the following reasons:

•       dementia, psychosis, hemiplegia, ataxia, blindness (both temporary and
        permanent);

•       respiratory insufficiency severely limiting independent activity;

•       cardiac failure severely limiting independence, recent coronary occlusion or
        peripheral vascular disease severely limiting independence;

•       amputation or arthritis severely limiting independence;


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                                  Notes for Physiotherapists


•       recent surgery severely affecting capacity to use public transport;

•       conditions that would cause the veteran to be either gravely embarrassed or
        unacceptable to other passengers in public transport (eg. incontinence of
        bladder or bowel, gross deformity or disfigurement);

•       significant trauma;

•       frailty that severely limits independence; or

•       public or private transport is not available.

A veteran may submit a claim for reimbursement of taxi fares, however
reimbursement will only be made if the health provider certifies on the claim form
that this type of transport was medically required. Without this certification
payment will only be made at the current private motor vehicle per kilometre rate
for the distance travelled.
Authorisation for reimbursement of taxi expenses on one occasion does not
necessarily mean that DVA will approve all future requests as this will
depend on the patient’s medical condition at the time of travel.


8          COMMUNITY TRANSPORT GROUPS
A veteran can travel by community transport if the health provider certifies on the
appropriate form that it is medically necessary. In some states (not South
Australia or Victoria), DVA has agreements with community transport groups,
where DVA is billed directly for transport provided. More information on
community transport arrangements is available by contacting the relevant DVA
State Office.


9          ATTENDANTS
If, due to a medical condition, a veteran requires an attendant to accompany them
while obtaining treatment, the attendant may also receive travel assistance.
Reimbursement will only be made if the health provider certifies on the claim
form that an attendant was medically required. Without this certification no
payment will be made for the attendant.



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                               Notes for Physiotherapists

10      FURTHER INFORMATION
If you require further information, please contact the Repatriation Transport Unit
in the DVA State Office for your State or Territory.




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            Notes for Physiotherapists




             APPENDIX C




        DVA SCHEDULE OF FEES

          PHYSIOTHERAPY




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        Notes for Physiotherapists




10/99              64
                           Notes for Physiotherapists


            SCHEDULE OF FEES FOR PHYSIOTHERAPY
                                    1999

ITEM                     DESCRIPTION                    FEE $
 NO
PH10    Initial consultation – rooms                    $39.40
PH11    Initial consultation – home                     $48.15
PH12    Initial consultation – public hospital          $48.15
PH13    Initial consultation – private hospital         $48.15
PH14    Initial consultation – nursing home             $48.15
PH15    Initial consultation – hostel                   $48.15
PH16    Initial consultation – public hospital          $39.40
        2nd & subsequent patients
PH17    Initial consultation – private hospital         $39.40
        2nd & subsequent patients
PH18    Initial consultation – nursing home             $39.40
        2nd & subsequent patients
PH19    Initial consultation – hostel                   $39.40
        2nd & subsequent patients
PH20    Standard consultation – rooms                   $31.65
PH21    Standard consultation – home                    $40.40
PH22    Standard consultation – public hospital         $40.40
PH23    Standard consultation – private hospital        $40.40
PH24    Standard consultation – nursing home            $40.40
PH25    Standard consultation – hostel                  $40.40
PH26    Standard consultation – public hospital         $31.65
        2nd & subsequent patients
PH27    Standard consultation – private hospital        $31.65
        2nd & subsequent patients
PH28    Standard consultation – nursing home            $31.65
        2nd & subsequent patients
PH29    Standard consultation – hostel                  $31.65
        2nd & subsequent patients
PH30    Extended Consultation - rooms                   $47.50
PH31    Extended Consultation - home                    $56.25
PH40*   Lymphoedema                                     $2000
PH50    Group physiotherapy                              $20
PH60    Supervised individual hydrotherapy              $31.65


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                                  Notes for Physiotherapists


ITEM                           DESCRIPTION                              FEE $
 NO
PH61*       Supervised group hydrotherapy (charge the usual              $29
            market rate, but no greater than maximum fee)
PH62        Unsupervised hydrotherapy – pool visit                        $8
PH80*       Unsupervised hydrotherapy – pool pass                        $300
PH91*       Physiotherapy treatment aids                                 $150

Please note that the item numbers in bold require prior financial
authorisation from DVA.

*The set fee is a maximum fee. You claim up to the maximum fee for:

•       the total cost of the service/s delivered as a part of lymphoedema treatment;

•       the actual cost of the pool pass for the veteran; or

•       the invoiced cost of the aid prescribed.




10/99                                        66

				
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