Billable Service – understanding the NDIS

29 August 2022

When it comes to the NDIS, what constitutes as a billable service can be confusing. There are strict guidelines outlining what One Central Health and other registered providers can and cannot charge for.

Registered NDIS provider

As a registered NDIS provider, we operate according to the strictest policies and procedures outlined by the NDIS Quality & Safeguards permission. Our client-centric supports are guided by our internal policies as well to ensure best practice, duty of care and therapy.

Our billable services are similarly under continuous review to ensure compliance with all standards and regulations.

The NDIS Quality and Safeguards Commission is an independent agency established to improve the quality and safety of NDIS supports and services.

NDIS Commission

Billable services – understanding what is and isn’t billable

To help summarise the somewhat complex NDIS Commission’s guidelines, we’ve answered some of the most commonly asked questions related to billable services.

Please note: (a) the following information is current as of the writing of the article but is subject to change. For the most up to date regulations, please see the NDIS Pricing Arrangements and Price Limits; (b) the following guide is meant to be a helpful summary of guidelines related to One Central Health services and should not be consulted as an exhaustive or comprehensive ruling.

What are the guidelines for billable services according to the NDIS Commission?

All billable services must comply with the following rules:

1. All billable services are in line with the support outlined in the NDIS Pricing Arrangement.
2. All services are outlined in a provided and signed Service Agreement.
3. Be a part of the provision of a specific disability support item to the participant/client.
4. Be explained to the participant and agreed to beforehand, including explanations regarding why the services are deemed clinically necessary.

What services are billable according to the NDIS?

Face-to-face services

Face-to-face services refer to therapy, support or other services provided in person with the clinician or service provider.

Telehealth services

Telehealth services refer to the provision of service through a virtual platform.

Non-face-to-face services

These billable services refer to any relevant and necessary service in line with the Pricing Arrangement that are not delivered in person or directly to the participant. More on this in a moment.

Travel

Billable travel is related to the provision of services and support. See below for more clarification.

Short notice cancellations and ‘Did Not Arrives’ (DNA)

Billable late cancellations can be in relation to any of the above mentioned services if they comply with the rules of the Pricing Arrangement.

NDIA reports

This billable services refers to reports that are requested by, provided to or required by the National Disability Insurance Agency (NDIA).

What services are NOT billable according to the NDIS?

Services that fall in one or more of the following categories are not billable:

• Failing to comply with the NDIS Pricing Arrangement.
• Not outlined in the Service Agreement.
• Not having been explained and agreed to before engaging in the services.
• Not directly delivering support to the participant. For example: rostering clinical staff, admin duties, bookings, upskilling and training staff, staff management.
• Pre-engagement activities not directly providing support. For example: arranging the Service Agreement, booking in therapy, monitoring plans, processing payments or providing quotes.

What non-face-to-face services are billable?

Not all non-face-to-face services are billable.

Billable

• Email writing or responding to or with the participant, other allied health providers or stakeholders e.g. teachers is billable!
• Phone calls with the participant, other allied health providers or stakeholders e.g. teachers are billable!
• Case meetings or research that is directly required to meet the needs/goals of the participant are billable!

Not-billable

• Booking appointments, raising/sending invoices and other administrative tasks are not billable!
• General communication that does not meet the conditions of the Pricing Arrangement are not billable!

What kind of travel is considered a billable service?

The following travel is considered billable:

• Travelling to and from a participant for a face-to-face appointment from the provider’s usual place of work.
• Travelling to a participant for a face-to-face appointment from another participant’s face-to-face appointment.
• Parking fees, public transport fees and road tolls related to the two above forms of travel.

All billable travel must comply with the following:

• Be pre-agreed travel outlined in a Service Agreement.
• Be up to a maximum of 30 minutes in areas classified between MMM1 and MMM3, and a maximum of 60 minutes for areas classified MMM4 to MMM5.
• Include a charge of up to $0.97 maximum for each kilometre travelled by a non-accessible modified vehicle.

It’s important to note that travel to a face-to-face appointment from the residential home of a clinician or service provider is NOT billable.

What is a ‘Short Notice Cancellation’ or ‘Did Not Arrive’ billable service?

According to the NDIS Pricing Arrangement and Price Limits, all short notice cancellations are billable. The term “short notice” means any cancellation that occurs less than two business days before the start of the appointment.

This includes appointments when the participant does not show up within a reasonable amount of time from the start time i.e. Did Not Arrive.

The additional following requirements must be met for a short notice cancellation to be billable:

1. The service and short notice cancellation needs to meet the conditions in the NDIS Pricing Arrangement.
2. The provider’s short notice policy must be outlined and agreed to by the participant i.e. in a Service Agreement or acknowledged policy.
3. Supports must be less than 8 hours long and less than $1,000 in value.

Service providers are expected to find other billable work in the event of a late cancellation or non-arriving participant. If, however, they are unable to find another billable service to replace the appointment with and the staff member is being paid by the employer for their time then the support is billable.

Which reports are considered billable?

Reports that are requested by the participant for the purpose of provision to the NDIA are billable. Reports should be billed to participants once they are completed.

Looking for more billable service information?

If you’d like more information about all things service related, support provision and what is and isn’t a billable service, please don’t hesitate to get in touch with the One Central Health team today.