Billable hours, that age old question

There still seems to be some mystery surrounding what is and what is not billable time under the NDIS. Some of this confusion comes from Allied Health providers working and billing under different systems. For instance, what can be billed under Medicare is different than what can be billed under the NDIS. Keeping track of so many funding systems is hard, so I have provided a guide to assist you in understanding what can and can’t be billed under the NDIS.

Face-to-face/telehealth appointments

Time spent with an NDIS participant either in a face-to-face session or via telehealth is billable time.

1.     Non-face-to-face supports

Under the NDIS, Allied Health providers are also allowed to bill for non-face-to-face service provision. This may include things such as emails and phone calls to and from the participant or another Allied Health provider, as long as they meet the conditions in the NDIS Pricing Arrangements and Price Limits. Alternatively, it may be a case meeting or research pertaining directly to the needs and goals of the participant. Note, however, that administrative tasks such as booking appointments and invoicing are not considered billable tasks.

2.     Travel

Time spent travelling to a participant – such as an appointment at a place of their choosing like their home or school – is billable time under the conditions outlined in the NDIS Pricing Arrangements and Price Limits. In short, these conditions state that providers can claim for travel when

• The NDIS Pricing Arrangements and Price Limits indicate that travel can be claimed for the support item

• The provider is delivering a specific disability support to the participant face to face

• The provider has explained to the participant why charging for travel represents the best use of their plan funds

• The provider has the advance agreement of the participant to charge for travel (including the travel costs that will be charged)

• The provider is required to pay the staff member delivering the support for the time they spend travelling (sole traders can also charge if they are travelling from their usual place of work or travelling between participants)

Note that Allied Health providers can claim for travel both TO and FROM their appointment with a participant, up to a maximum of 30 minutes each way in MMM1-3 areas and 60 minutes each way in MMM4-5 areas. The claim for time taken to travel is billed at the usual hourly rate billed by the Allied Health provider for the provision of the service. 

In addition to billing for the time taken to travel to and from an appointment, the NDIA consider the following to be a reasonable contribution towards the cost of travel

• up to $0.85 a kilometre for a vehicle that is not modified for accessibility, and

• other forms of transport or associated costs up to the full amount, such as road tolls, parking, and public transport fares.

So, let’s use the scenario that an OT left the office and travelled 10 km each way to attend an appointment in the participant’s home.

NB: Claims for non-labour costs associated with travel (kilometres, parking fees, tolls, etc.) are invoiced with a different code, which will change depending on which Allied Health service is being provided. 

3.     Short notice cancellations

Short notice cancellations are also billable under the NDIS, provided they meet the conditions set out in the NDIS Pricing Arrangements and Price Limits. A shortened version of these conditions is as follows:

• When the participant does not show up to an appointment within a reasonable time of the appointment’s start time

• If the support is less than eight hours long, the cost of the support is less than $1,000, and the person has given less than two business days’ notice to cancel the appointment – otherwise, five days’ notice is required

• If the NDIS Pricing Arrangement and Price Limits indicate that short notice cancellations can be charged for the support item and complies with all the general claiming rules

• If the provider has an agreement with the participant in advance that short notice cancellations can be charged

• If the provider was unable to find alternative billable work for the staff member and is required to pay that staff member for their time.

4.     NDIA-requested reports

Finally, let’s talk about NDIA-requested reports. This is not a report that a participant may request for another reason – it is only for the purpose of the NDIA.

Let’s say that the participant has called the OT and let them know that they have a full plan review meeting scheduled for eight weeks’ time and would like a Progress Report written. This would be an NDIA-requested report and can be invoiced.  

The above examples are just that: examples. They are intended to be a guide and not replicated exactly, as every individual’s circumstances are unique. It is also important to note that being allowed to bill for something and actually doing it are two different things. For example, in the NDIS Pricing Arrangements and Price Limits, one condition for being able to bill for travel is that the provider has explained how their charge for travel represents the best use of a participant’ funds. A provider must also have an agreement with the participant which clearly explains the travel costs that will be claimed. Billing under the NDIS is no easy task. Ensuring that you claim for all your billable hours while meeting the conditions of the price guide, however, can assist in producing a long-lasting, viable Allied Health practice.