Ask DSC: When the participant doesn’t pay the invoice

"We are a small, independent support work provider. A couple of our self-managed clients have not been paying their invoices. We didn’t get into this business for the money, but we are a small business and can’t really afford unpaid invoices. We’ve had a few of those awkward money conversations with those participant, but the bills remain unpaid. What are our next steps? Do we stop providing support until the invoices are paid? How do we handle this in a way that aligns with our values?" 

You have to love a small service provider with a big heart. However, unpaid invoices create a real financial risk to providers, so let’s look at a plan to resolve this dilemma and minimise similar risks in the future.

Start here – some easy fixes

If you are a provider with outstanding invoices for support provided to a self-managed NDIS participant, start with the basics:

• Has the participant received the invoice?
• Check contact details and follow up to ensure receipt
• Does the participant agree with the dates, amounts, supports, and services included on the invoice?
• Common sticking points can include cancellations, non-face-to-face time, report writing, and kilometres for participant transport and provider travel
• Try to resolve minor billing disagreements by explanation or concession. This could smooth the payment process and get funds flowing again
• Is the participant able to access their plan to make the payment request via the NDIS participant portal or the new NDIS mobile app?
• Even the best of us can forget a password or the answer to a secret question that we set on myGov all those years ago
• Claiming via the portal can be complicated. Support categories have one name on a participant’s printed plan and a different name on the NDIS portal. For example: therapies funded under Improved Daily Living are claimed under CB Daily Activities on the portal, and in-home support funded under Core Supports in a plan are claimed under Daily Activities on the portal. Check the language protocol your invoicing system uses and adjust if required
• Hint: There is handy conversion guide in NDIS Participant Booklet 3 (pages 5–7)

If the source of payment delay isn’t among the easy fixes, then we need to dive deeper. Is it that your self-managing participant can’t pay or, worse, won’t pay?

Can’t pay

If a self-managing participant can’t claim an invoice because of technical issues, then they could get support from

• The NDIS myplace Portal Step-by-step guide: recently updated, this resource includes screen shots from the myGov and NDIS participant portals
• The NDIS myplace Participant Portal System Messages and Error Codes: includes the most common and most obscure error messages that the portal can throw up
• Using a manual claim form: the MyPlan Purchase Payment Request Form is available in both MS Word (.docx) and PDF formats and can be used if the participant can’t access the participant portal. Payments are processed “promptly” by the NDIA (read that as payment within days/weeks rather than months/years)

A support coordinator or local area coordinator (LAC) could support the person to flexibly and creatively use their current plan budget. However, if a person can’t pay an invoice because they don’t have enough funding available, their options include

• Submitting a Change of Details or Change of Situation
• Requesting an Internal Review of a Decision
• Pursuing an external review at the Administrative Appeals Tribunal

For the record, I have never seen a new NDIS plan “backdated” to cover support delivered in excess of funding in a previous plan period. Providers should proceed with extreme caution if they are aware that there is no funding available to cover the support delivered. The participant should be directed to contact the NDIA, advise the Agency of their situation, and clearly detail the risk(s) they face without access to funded supports.

Won’t pay

If a self-managing participant has your invoice, has funds available in their NDIS plan, and simply won’t pay, you need an alternative resolution strategy:

• Ask nicely: send a reminder, marked “Overdue”, with payment terms and details highlighted
• Refer to the NDIS Guide to Self-Management: it states that “responsibilities of self-managers include claiming and paying for supports by making payment requests and paying for your supports on time” (page 4). The guide is also available in an Easy English version that states “you must also make payment requests and pay for services on time” (page 9)
• Refer to the new NDIS Self-management Policy point 7.15, which states that “evidence of mismanaging the funds for supports in a participant’s plan is likely to be considered an unreasonable risk that prevents the participant, child representative or nominee from managing all or part of the funding for supports in a participant plan. This is based on the risk that participants may incur a debt or be unable to pay providers” (page 8)
• Refer to the service agreement: draw the participant’s attention to the terms of the agreement that binds both parties
• Set a firm boundary for continued service delivery: choose a cut-off date that is in accordance with the terms outlined in your service agreement and your organisational values, and put the participant on notice that supports will be suspended from that date if payment isn’t received
  

Strengthening Service Agreements with self-managers

If your Service Agreement is lacking in clarity, then let’s see examples of how other providers have strengthened their payment terms, limited exposure to unpaid invoices, and provided a framework for those awkward money conversations.

Payments: 'If participants are more than one month behind in payments for provision of support, then they will not be permitted to come back on the program until all payments are cleared'.

Suspension of Services: 'The provider may suspend the delivery of services in the event that the participant/representative fails to pay the amount required for the service delivered'.

Meanwhile, this provider has translated their Service Agreement Terms and Conditions into the language, mode of communication and terms that the participant is likely to understand and provided a link to a video explainer in Auslan.  Terms of Payment for Self-Managed Participants: ‘Self-Managed participants are required to pay their invoice within 14 days of the invoice date’ (7 min 20 sec) and liability where insufficient funds: ‘Self-Managed: the participant’ (7 mins 40 sec).

What do the NDIS Practice Standards say?

We all agree that ceasing, or threatening to suspend funded support, would be a serious move which might be at odds with a provider’s values.  So let’s check how the NDIS Commission Practice Standards and Quality Indicators guide providers:

Section 2: Provider Governance and Operational Management, Continuity of Supports, Outcome: Each Participant has access to timely and appropriate support without interruption (page 11)

Section 3: Provision of Supports, Access to Supports. Indicator: Each participant is supported to understand under what circumstances supports can be withdrawn (page 12)

Out of adversity comes opportunity

If you are struggling with payments from self-managers, it could be tempting to exclude them from services. However, as approximately 30% of the NDIS market wholly or partly self-manage, that could be bad for business and bad for participants.

Hidden in the Pricing Arrangement and Price Limits is line item 01_134_0117_8_1 “Capacity Building and Training in Self-Management” @$70.87 per hour. Tasks that can be considered self-management capacity building include building organisational skills, engaging providers, developing service agreements, building financial skills, maintaining records, and claiming payments from the NDIA and paying providers.

Could the answer to your dilemma be to provide more support rather than less? Could one of your team members provide self-management capacity building support to participants? Could this be an employment opportunity for a skilled self-managing participant?

Self-managing participants and nominees are swamped with life admin, so portal changes, plan glitches, and payment request rejections can be completely overwhelming. Before you pull the plug on service provision, or even worse, call in debt collectors, try offering additional support to your self-managers. You could build capacity, lighten their load, and win their lifelong loyalty. That sounds like a strategy that aligns with organisational values.