A worker is entitled to recover costs for their reasonable medical and related expenses. These fall under the heading of approved treatments and include such things as, visits to and treatments by the worker’s general practitioner and specialist, physiotherapist and occupational therapist.
See the Rates, fees and payments page to view how WorkCover WA quantifies these entitlements.
Charging for medical treatmentsWorkCover WA specifies rates billable under the workers compensation system for the most commonly used medical services (also known as ‘scheduled items’). These rates (or ‘scheduled fees’) represent the amount that the insurer will reimburse the worker for the treatment provided. If a service provided to an injured worker does not have a scheduled fee, the fee shown in the Australian Medical Association’s List of Medical Services and Fees will usually apply.
If the claim is denied, the injured worker is responsible for prior and future treatment costs and should forward such accounts to Medicare (and/or their private health fund) for a rebate.
Disputes over unpaid invoices should first be taken to your patient’s employer or insurer. If you are unable to resolve the dispute you can lodge an application with the Workers Compensation Conciliation Service.
Medical Practitioners
Medical practitioners can use the MBS number as their code – see the Medicare Benefits Schedule website for information.
Other practitioners
Practitioners other than doctors can use the service codes available on the Rates, fees and payments page.
Unavailable service code
If the service code is not listed among WorkCover WA’s scheduled items, the code may be found in either the Australian Medical Association’s List of Medical Services and Fees, or on the Medicare Benefits Schedule website. You should discuss the payment of the service fee with the workers compensation insurer – the fee shown in the AMA’s List is usually acceptable to the insurer in these cases. Be sure to include a clear description of the service provided on your invoice to the workers compensation insurer.
Billing practices for medical and radiology services
All service providers should be cognisant of WorkCover WA’s fees for scheduled items and AMA fees for unscheduled items. Service providers are also expected to provide transparency and clarity with regard to the billing of medical services.
Surgery Proposal Template
WorkCover WA, in conjunction with insurer representatives, has developed a Surgery Proposal Template to provide transparency about billing for planned surgeries for injured workers.
