Early Intervention Physiotherapy Framework

*** This policy is effective from 18 August 2014 ***

The TAC Medical Excess may apply to these services 

 

 

Policy

The TAC can pay the reasonable costs of services delivered under the Early Intervention Physiotherapy Framework where required as a result of a transport accident injury under section 60 of the Transport Accident Act 1986 (the Act).

The TAC will periodically review a client's entitlement to physiotherapy services to ensure that they remain reasonable for the transport accident injury and are payable under the Act.

Background

The Early Intervention Physiotherapy Framework is a service model that recognises the importance of early treatment in facilitating return to work (RTW) and return to health outcomes.

Any physiotherapist can enroll in the Early Intervention Physiotherapy Framework by completing the required training and signing a declaration to provide services in line with the Clinical Framework.

The TAC has developed the Clinical Framework for the Delivery of Health Services which is a set of guiding principles intended to support healthcare professionals in their treatment of an injury through:

  • Measurement and demonstration of the effectiveness of treatment 
  • Adoption of a biopsychosocial approach 
  • Empower the client to manage their injury 
  • Implementing goals focused on optimising function, participation and return to work 
  • Base treatment on best available research evidence.

The TAC expects that all health professionals providing services to clients integrate the principles of the Clinical Framework into their daily practice.

Further information about the Clinical Framework can be found at www.tac.vic.gov.au.

This policy must be read in conjunction with the following:

Guidelines

What can the TAC pay for in relation to Early Intervention Physiotherapy Framework services?

The TAC can pay the reasonable cost of services:

  • required as a result of a transport accident injury
  • provided by TAC enrolled physiotherapists
  • that are clinically justified
  • that promote progress towards functional independence, participation and self-management
  • that are proven to be effective and achieve or maintain a measurable functional improvement
  • that are focused on achieving health and return to work outcomes
  • that are reasonable, necessary or appropriate in the circumstances
  • that are safe and effective
  • in accordance with the TAC policies and guidelines

Once a physiotherapist agrees to the declaration and is enrolled by TAC as a physiotherapist providing EIPF services, they may no longer bill traditional physiotherapy item numbers. All services must be billed in accordance with the Early Intervention Physiotherapy Framework Fee Schedule.

Initial and standard consultations 
The Early Intervention Physiotherapy Framework model has been developed to facilitate return to work and return to health outcomes.

The initial consultation is recognised as an important opportunity for the EIPF provider to influence return to work and recovery outcomes. Accordingly, the initial consultation is paid at a higher rate than the standard consultation. The higher initial consultation rate is available for seven months from the client's date of injury.

Attached to this higher fee is the expectation that, when appropriate, the physiotherapist makes contact with any other key parties in the return to work / return to health process, such as the Employer or GP. In addition, the initial consultation fee includes the completion of a Treatment Notification Plan if the client is expected to require more than five sessions.

Consistent with a focus on early intervention and safe and sustainable return to work and return to health outcomes, standard consultations are also reimbursed at a higher rate for a period of seven months from the client's date of injury.

For more information please refer to the Early Intervention Physiotherapy Framework Fee Schedule.

Post-operative Physiotherapy 
Physiotherapists providing services under the Early Intervention Physiotherapy Framework are eligible to be paid a higher rate for treatment occurring after certain specific endorsed surgical and procedural interventions. This post-operative rate recognises that certain procedures return the injury to an acute state, and that more intensive treatment and greater communication between stakeholders is required to achieve optimal rehabilitation and return to work outcomes.

The post-operative item number can be billed for a maximum of 3 months of treatment following an endorsed procedure, provided the procedure occurs within 2 1/2 years of the date of work-related/traffic accident injury. The 3 month eligibility period commences from the first treatment by the physiotherapist following an endorsed procedure.

For a list of approved procedures, please refer to the EIPF Post-operative endorsed procedure list.

Workplace Assessment and Report 
Physiotherapists can play a key role in safe and sustainable return to work and health. Accordingly, the TAC encourages physiotherapists providing services under the EIPF to consider whether conducting a Workplace Assessment would help an client.

A Workplace Assessment is a proactive intervention that can be used to facilitate better return to work and health outcomes for clients. Some general guidelines for when a workplace assessment may be appropriate include:

  • As an early intervention tool to initiate a return to work
  • To confirm the availability and/or suitability of modified or alternative duties 
  • To confirm time-frames for an injured client to return to work if certified totally/partially unfit for work
  • To discuss suitable work duties and hours to support a return to work plan
  • If the client has reported difficulties in sustaining employment
  • To discuss and address any identified return to work barriers.

The TAC recognises that workplace environments and conditions vary greatly. Accordingly, workplace assessment reports submitted to the TAC will differ according to the individual circumstances of the client's workplace. A workplace assessment report completed by an EIPF provider should contain the following basic information:

  • Client details (name, claim number, Employer, DOB, date of injury, nature of injury / diagnosis)
  • Workplace Assessment details (date of visit, location, attendees)
  • Pre-injury duties and hours (brief description)
  • Current status of the client (including certified capacity, work status, and RTW goals)
  • Identified barriers and proposed solutions / alternatives
  • Suitable duties identified
  • Conclusions (duties and positions identified, current capacity and how this relates to identified duties, recommendations for future RTW supports)
  • Other (follow-up discussions with GP, client, employer, other stakeholders)

The Workplace Assessment and Report item is billed on an hourly basis, to a maximum of 3.5 hours. The fee for a Workplace Assessment and Report includes:

  • time spent arranging the assessment;
  • travel time to the client/injured worker's workplace;
  • time spent undertaking the assessment; and
  • report writing.

Prior approval from the client's employer is required before a Workplace Assessment is conducted on premises.

Extended consultations
The TAC can pay for extended consultations where the physiotherapist, using the appropriate request form, has submitted written clinical justification of the need for direct patient contact time of greater than 30 minutes per session for clients who have:

  • a significant acquired brain injury
  • a spinal cord injury
  • lympoedema
  • severe burns
  • complex and multisite orthopaedic injuries
  • limb amputations; or
  • crush injuries.

Physiotherapists treating a client who meets the above criteria are eligible to be paid a higher extended consultation fee for the period of nine months from the client's initial physiotherapy consultation.  Prior written approval is required for all extended consultations and consultations can only be billed as a single consultation on any one day.

Extended consultations can be for periods of either:

  • 31-40 minutes 
  • greater than 40 minutes

For more information refer to the Early Intervention Physiotherapy Framework Fee Schedule.

Travel
The TAC can pay the reasonable costs of travel on a per kilometre basis for physiotherapists providing treatment outside their clinic other than when conducting a Workplace Assessment and report. Travel is defined as the physiotherapist driving a registered motor vehicle from their clinic address to an approved community consultation. 

Approved consultations in a community setting are paid at the standard or extended consultation rate, inclusive of the higher fee rate where applicable. The cost of travel is paid on a per kilometre basis. For more information refer to the Early Intervention Physiotherapy Framework Fee Schedule.


The TAC expects a client to seek treatment from a physiotherapist within their local area. Travel can only be paid where:

  • no other physiotherapist offering an equivalent service is situated within a 30 kilometre round trip of the client; and
  • travel to the client is clinically justified.

A request for travel must include the following:

  • the client name and claim number
  • the specific conditions and injuries to be treated
  • the clinical justification as to why travel is required
  • whether or not there are other reasonable transport options available to the client
  • the approximate distance and cost per episode of travel (round-trip); and
  • the number of travel episodes requested.

Travel is only payable with prior written approval from the TAC. The per kilometre rate paid for travel is different for regional and metropolitan areas. Travel is paid at the applicable rate where most of the travel occurred. For example, 10km in a regional area and 20km in a metropolitan area would result in payment for 30km of travel at the metropolitan rate. Metropolitan and regional areas are as defined by the Victorian Department of Health and Human Services.

Travel must be recorded from the rooms nearest to the client's location where a physiotherapist has more than one practice address.

The physiotherapist must record the distance from one appointment to the next when clients are treated consecutively, not from each appointment to the practice.

When invoicing for travel, the physiotherapist must record the:

  • number of metropolitan and/or regional kilometres travelled
  • applicable metropolitan or regional rate; and
  • item number

Please refer to the Early Intervention Physiotherapy Fee Schedule for further information.

Who may provide services under the Early Intervention Physiotherapy Framework?

Services must be delivered by a physiotherapist who:

  • is registered  with the Physiotherapy Board of Australia
  • has satisfactorily completed the TAC training modules 
  • has signed a declaration committing to provide services in line with the Clinical Framework and related Service Standards; and
  • has received confirmation of enrolment from the TAC.

What information does the TAC require to consider paying for Early Intervention Physiotherapy Framework services?

Clients can access physiotherapy services for a transport accident injury without prior approval from the TAC or referral from a medical practitioner.

For clients with a 'severe injury' treatment may be approved as part of the independence planning process. The physiotherapist will be required to submit baseline measures within 10 working days of approval of treatment from the TAC. Outcome measures are to be recorded throughout treatment and provided to the TAC upon request.

For all other clients the TAC does not require any information from a physiotherapist before commencement of initial treatment for a client's transport accident injury.

After initial treatment has commenced, the physiotherapist must submit to the TAC a Physiotherapy Treatment Notification Plan, including baseline measures, where:

  • the physiotherapist expects to provide more than five sessions of treatment
  • the client has attended a different physiotherapy clinic; or
  • the client has previously received physiotherapy treatment and it is more than 12 months since the last treatment session.

The TAC may request a report from the physiotherapist if a client requires additional services after the approved treatment. The TAC will decide whether the additional services are reasonable in the client's circumstances.

When will the TAC respond to a request?

The TAC will respond to written treatment and service requests as set out in the TAC Service Charter.

The TAC Clinical Panel may contact the physiotherapist to discuss the proposed treatment to the client. Where this occurs the TAC will decide on the treatment requested after receiving the Clinical Panel recommendation.

What are the TAC's invoice requirements?

Please refer to How to Invoice the TAC on our website.

What fees are payable for Early Intervention Physiotherapy Framework services?

Please refer to the TAC Early Intervention Physiotherapy Framework Fee Schedule.

In relation to Early Intervention Physiotherapy Framework services, what won't the TAC pay for?

The TAC will not pay for:

  • treatment or services for a person other than the client
  • treatment or services not authorised by the TAC under the Transport Accident Act 1986
  • more than one initial consultation by the same provider or clinic
  • items that are not charged under the Early Intervention Physiotherapy Framework Fee Schedule
  • the provision of multiple or concurrent physical treatments (for example early intervention physiotherapy, physiotherapy, chiropractic, osteopathy or acupuncture) with exceptions such as group exercise or group hydrotherapy
  • pharmacy items such as creams and gels supplied by health professionals
  • treatment or services subcontracted to, or provided by a non-registered provider
  • fees associated with cancellation or non-attendance
  • treatment or services provided outside the Commonwealth of Australia
  • treatment or services provided by telephone or other non-face to face mediums
  • telephone calls and telephone consultations between providers and clients, and between other providers, including hospitals
  • multiple claims for travel to and from the practice for community consultations provided consecutively
  • consumable prosthetics, aides and appliances used in the course of the consultation – for further information please refer to the Equipment Policy
  • services provided more than once on the same day to the same client
  • treatment, services, prostheses or equipment where there is no National Health and Medical Research Council level 1 or level 2 evidence that the treatment, service, prostheses or equipment is safe and effective - refer to the Non-Established, New or Emerging Treatments and Services Policy
  • treatment or services provided more than two years prior to the request for funding except where the request for payment is made within three years of the transport accident.  Refer to the Time Limit to Apply for the Payment of Medical and Like Expenses Policy.

Early Intervention Physiotherapy Framework Services

Effective 1 July 2017

Service DescriptionTAC Item Number2017/18 Maximum Payment Rate2016/17 Maximum Payment Rate
Initial Consultation: History, examination and treatment of new patient
Initial Consultation: < 7 months from date of injuryEPA100$101.50 $100.02
Initial Consultation: > 7 months from date of injuryEPB100$70.02 $69.00

Standard Consultation
 
Standard Consultation: < 7 months from date of injuryEPA102$67.01 $66.03
Standard Consultation: > 7 months from date of injuryEPB102$53.35 $52.57
Post-operative consultation: Eligible surgical procedures only - see guidance material for details; can be billed for a maximum of 3 months from first treatment following eligible surgery; Can only be billed within 30 months of the date of injury.
Post-operative Consultation: max. 3 months of treatmentEIP001$67.01 $66.03

Extended Consultation:
Prior approval required - refer to the policy for eligibility criteria
Extended Consultation (31-40 mins) : < 9 months from first community treatmentEPA107$89.33 $88.03
Extended Consultation (31-40 mins) : > 9 months from first community treatmentEPB107$66.74 $65.77
Extended Consultation (+40 mins) : < 9 months from first community treatmentEPA108$111.68 $110.05
Extended Consultation (+40 mins) : > 9 months from first community treatmentEPB108$106.60 $105.05

Travel:
Prior approval required - refer to the policy for eligibility criteria. Cannot be billed where the service rate includes travel
Melbourne MetropolitanEPA131$2.72 per km$2.72 per km
Regional / RuralEPA132$1.84 per km$1.84 per km

Hydrotherapy & Group Consultations:
Hydrotherapy rates include travel
Individual Hydrotherapy ConsultationPH602R$53.35 $52.57
Group Hydrotherapy Consultation: Two or more patientsPH602G$32.38 $31.91
Group Consultation: Maximum 6 patients receiving constant overall supervision and intermittent individual attention from a physiotherapistPY602G$32.38 $31.91

Assessment & review:
Assessment and reviews include travel
Workplace Assessment and reportWPA101$155.05 per hour (max $465.15) $152.79 per hour (max $458.37)
Home/Equipment Inspection & ReportPY620H$117.28 $115.57
Completion of Physiotherapy Management Review ( at TAC request )PY630R$58.74 $57.88
Attendance at TAC Team Meeting ( at TAC request)PY625H$117.28 $115.57

GST

*The TAC maximum fee includes a 10% allowance for GST for items which TAC believes are taxable supplies.  If you are a provider not registered for GST:

  • You are not legally permitted to charge GST
  • You should indicate on all invoices submitted your status as 'not registered for GST purposes'
  • The TAC will only reimburse you an amount which excludes the GST component for items billed where the maximum fee includes a 10% allowance for GST

If you are not registered for GST please state on all invoices the TAC item number listed for providers not registered.


View Early Intervention Physiotherapy Framework - Information for physiotherapists

Early Intervention Physiotherapy Framework - Information for physiotherapists

Summary:

These fact sheets for physiotherapists explain the Early Intervention Physiotherapy Framework, including information about fees, billing, training and enrolment.

Follow these steps to join the Early Intervention Physiotherapy Framework:

  1. Ensure you are registered to provide services to the TAC
  2. Read the fact sheets below to decide if joining the EIPF is right for you (including the service standards and sample declaration)
  3. Complete the online training (hyperlink: http://www.earlyinterventionphysiotherapyframework.com.au)

    To log in, you need to register (the 'Register' button is on the right of the screen). This allows you to resume the training later if you need to.

    Questions throughout the training are for learning purposes only. Your answers will not affect your ability to enrol in the EIPF program.

    If you experience any issues, please email the following addresses. Technical support will be available Monday - Friday (8am - 5pm). info@vide.co.nz or cameron.gosling@monash.edu.
  4. Sign and return the declaration to:

    Email: provider@tac.vic.gov.au

    Your enrolment will start from the date your declaration is received by the TAC and VWA. A confirmation letter will also be sent, for your records.

Please send enquiries to provider@tac.vic.gov.au

View Information for people with soft tissue injuries

Information for people with soft tissue injuries

Summary:

This booklet provides information about soft tissue injuries (e.g. painful strains, sprains and bruises) and how health care professionals can help you recover faster by getting moving. As well as explaining the types of treatment and services the TAC can fund, there are handy tips about working with your therapy providers, staying motivated and measuring progress.

View Physiotherapy: treatment notification plan (TNP) form

Physiotherapy: treatment notification plan (TNP) form

Summary:

A treatment notification plan (TNP) includes information relating to a TAC client's clinical diagnoses, proposed treatment plan, self-management strategies and outcome measures.  A TNP is required to be submitted to the TAC if there has been a gap in treatment of longer than six months. For most new clients you will not need to complete a TNP unless specifically asked to do so. Clients with a 'severe injury' or in receipt of an 'Immediate approval of services' letter do not need a TNP submitted to the TAC prior to treatment. The TAC may request a TNP at other times during your patient's treatment.

View Physiotherapy: management review (PMR) form

Physiotherapy: management review (PMR) form

Summary:

This form is to be completed by physiotherapists to report on the progress and/or effectiveness of a client's physiotherapy treatment and self-management plan. The separate 'notes' document in this section provides additional instructions and clarification to help complete the form.

View Billing Review Program - Information for Allied Health Providers

Billing Review Program - Information for Allied Health Providers

Summary:

The TAC and WorkSafe conduct periodic reviews of payments made to providers for medical and allied health services provided to TAC clients and injured workers through the Health Practitioner Billing Review Program.

The primary focus of the program is to ensure that payments made to medical and allied health providers are appropriate and comply with TAC and WorkSafe policies and fee schedules.

View Independence Plan - Information for providers

Independence Plan - Information for providers

Summary:

Our attendant care providers support clients to achieve their independence goals in daily living activities, therapy support, personal and domestic skills retraining and community access skills.

View CMSO (Complex and Multi-site Orthopaedic Injuries)

CMSO (Complex and Multi-site Orthopaedic Injuries)

Summary:


This document outlines to Physiotherapists the TAC's Complex and Multi-site Orthopaedic injuries criteria