FAQ for Exercise Physiology fee schedule WorkcoverSA
1.EP101 states that I must treat in accordance with the Clinical Framework for the Delivery of Health Services. What does this mean?
The Clinical Framework for Health Services Delivery is designed to support health care providers to support healthcare professionals deliver the right care at the right time to individuals with a compensable injury. It has been endorsed and adopted by most compensable schemes within Australia, including WorkCoverSA and covers 5 principles of practice that health care providers are expected to adopt when working with clients from compensable environment.
WorkCoverSA and ESSA expect AEPs adopt the principles of the Clinical Framework within their clinical practice when providingservices to WorkcoverSA clients. A copy of the Framework can be accessed here and this You-tube video further demonstrates how the framework integrates into a clinical setting.
It is expected that each worker’s exercise program will differ according to their injury and circumstances. Hence, it is expected that only appropriate and necessary sessions are arranged with workers, and the maximum allocation of 10 sessions may not be required for all workers.
2.EP102 states a maximum of 10 sessions including initial assessment, individual session and group sessions. What if I have a complex client and require more sessions than this?
The purpose of exercise physiology services is to assess and prescribe functional exercise for the purpose of restoring an injured worker’s level of function so they may return to work in suitable duties/employment as soon as possible. It is also to assist the worker to transition to independent and self-directed management. In aligning services to the purpose of treatment as outlined in the exercise physiology service and payment policy it is anticipated that most clients can be transitioned to independent care within the allocated sessions. However, services provided outside of this fee schedule and policy can be considered by the worker’s case manager on a case-by-case basis.
3.For clinical reasons (i.e. to simulate work duties, improved motivation) my client needs to be seen in a gymnasium. How do I arrange this?
Where specific gymnasium equipment is needed due to the nature of injury, WorkcoverSA will consider reimbursement of the gymnasium entry fees to the worker. Reimbursement of gymnasium entry fees is governed by Workcover SA Aquatic and Gymnasium Facility fee schedule.
4.I run a mobile EP business, can I charge for travel?
The hourly rate paid by WorkcoverSA includes an overhead component for provision of facilities and infrastructure needed to deliver the services. WorkCoverSA does not pay travel costs or travel time for service providers to attend their place of work. Providers who offer a mobile service do so as a business model choice and WorkcoverSA does not pay for any associated travel costs.
5.I have finished providing my EP services and my client wants to keep going to a gym. Will WorkcoverSA fund this?
WorkCoverSA will only pay for services that are:
for the management of a work-related injury or illness
appropriate and necessary
in accordance with section 32 of the Act (insert link to this section of the Act here?)
in accordance with the Clinical Framework for the Delivery of Health Services
They do not pay for services focussed on improving a worker’s general level of health, fitness and wellbeing. If the client wants to continue with a gymnasium-based program for personal reasons, it would be their responsibility to fund this. Remember, an exercise physiology intervention is part of an overall strategy to assist the worker to transition to independence and self-directed management.
6.I have completed my exercise physiology intervention with the client, however the client has a particularly physical job that requires high levels of muscular strength and endurance. To ensure durable and safe return to work I would like the client to continue with an unsupervised gym program. Is this supported?
Workcover SA will pay a maximum of 10 individual/group sessions for workers regardless of whether the exercise program is home or gym based.
It is expected that independent exercise programs be developed by an allied health provider (such as an AEP, or physiotherapist) prior to a worker’s commencement of such a program. It is expected that this program be reviewed by the allied health provider once every four weeks, over the course of the exercise program to a maximum duration of three months.
Refer to the section “Unsupervised gym program” which outlines WorkCoverSA policy for further details of expectations of AEPs in establishing gym based programs.
7.Can I charge for travel?
WorkCoverSA does not pay travel costs or travel time for service providers to attend their place of work. Providers who offer a mobile service do so as a business model choice and WorkCover SA does not pay for any associated travel costs.
8.Can I charge for case conference with other members of the client’s treating healthcare team?
Under the WorkCover SA system, a case conference is focussed on clarifying or establishing return to work goals or other case management specific matters. It is not intended to substitute usual practitioner interactions for clinical management of a workers injury. These interactions are expected to occur in the same way as they do for non-compensable patients.