FAQs: Workplace support

Private health insurance rebates to patients are commercial decisions made by individual health funds.

If your HICAPS or Healthpoint terminal rejects a code:

• the item code may have been repealed and no longer exists
• the patient’s ancillary cover may not cover that particular item code
• a specific insurer may not recognise that item code, (eg, HCF does not recognise item code 561 for Class Consultations)
• ensure you are using the correct item code
• check coverage with the insurance company
• check with the insurance company that they accept the code you are entering.

A list of the PHI item codes can be accessed from the Professional and Clinical Resources page on Physio Hub.

Item code 560: group consultation of no more than six participants. Each participant in a group consultation must have an individually-tailored exercise program.

Item code 561: class consultation, which does not have a cap on the number of participants. Everyone in a class consultation completes the same program.

Some insurance companies have different policies related to groups and classes. It's recommended that patients choose an insurance policy that meet their needs.

HCF, for example, has clarified that they do not cover services that do not address a medical condition.

If you run groups or classes, you should ensure that the way you describe your groups or classes matches the following descriptors:

• Group (Item code 560): Groups typically have six participants or fewer who are being treated with individually designed interventions for the treatment of a specific health condition. Group physiotherapy requires pre-intervention assessment, individually designed interventions for each participant, re-assessment and clinical record keeping (for example, noting improvements and prognosis).
• Class (Item code 561): Classes may have any number of participants and participants all perform the same exercises. You must keep clinical records for all class participants.

Yes. Each physiotherapist must have their own provider number. You cannot use someone else’s provider number. A provider number is practitioner- and location-specific, so if you start practicing at a different location or move interstate, you must apply to Services Australia to obtain an additional provider number. Physiotherapists can contact Services Australia on 132 150.

A locum (locum tenens) cannot use another person’s Medicare provider number.

If the locum is working at a location for less than two weeks and will not be returning there, they should contact Services Australia (provider liaison - 132 150) to discuss their options. Typically, this means the locum will use one of their other provider numbers.

If a locum will be working at a location for more than two weeks or for less than two weeks but on a regular basis, the locum should apply for an additional provider number for the relevant location.

Physiotherapists can request diagnostic imaging services for which their patient may be eligible to receive a Medicare benefit.

Medicare benefits are generally not payable for diagnostic imaging services that are classified as R-type (requested) services when requested by a physiotherapist, with certain exceptions.

Some NR-type (not requested) diagnostic imaging items can be used by physiotherapists. However, the patient’s eligibility to receive a Medicare benefit is dependent upon the diagnostic imaging service provider determining the clinical relevance of the service. Hence, it is a good idea to establish a relationship with the imaging providers in your area.

The APA recommends that members do not refer patients for MRI scans, if the referring physiotherapist does not have the necessary skills to interpret the MRI data, and they should refer the patient to a GP and request a copy of the radiologist's report.

Further, MRIs ordered by a physiotherapist are not eligible for a Medicare rebate so the patient would be out-of-pocket.

You should ensure any method of storage meets the requirements of the national Privacy Act and state/territory privacy legislation. You may use the cloud to store data - the Office of the Australian Information Commissioner provides guidance on storing data in the cloud.

If using a cloud-based PMS, physiotherapists still have privacy obligations to their patients under the Australian Privacy Principles. Consequently, physiotherapists must take reasonable steps with their cloud service provider to ensure the provider correctly manages the storage and handling of patients' data. Physiotherapists can do this through their contracts with the provider, verifying the provider’s security claims, reviewing regular reports from the provider, as well as monitoring the service.

Clinical notes describe how physiotherapists understand their patients. Clinical notes facilitate safe, high-quality care and demonstrate physiotherapists’ accountability for their practice. APA members can access the APA guidelines on writing clinical notes.

• Clinical records must contain sufficient information to allow a physiotherapist of similar skill to continue the treatment of that patient, if required.
• All abbreviations, terminology and symbols within the clinical record should be recognisable by physiotherapy peers.
• Physiotherapists must accurately document all interactions where they engage in their patient’s management. All entries are accurate statements of fact or statements of clinical judgement.
• Records must document each attendance and be completed contemporaneously or as soon as practicable after the consultation. When appropriate, cancelled or missed appointments should also be recorded.
• Physiotherapists must document that they obtained their patient’s informed consent before they assessed and treated the patient.
• Clinical records must be dated, and if appropriate, include the time of the consultation.
• They must be legible and signed by the treating physiotherapist with the physiotherapist’s name clearly printed.
• Where a service is provided by a physiotherapy student, the records must be countersigned by the supervising physiotherapist.

The Privacy Act applies to all private sector health service providers anywhere in Australia. If you work in NSW, Victoria and the ACT, private sector health service providers must comply with both Australian and state or territory privacy laws. For adult patients, records must be securely stored for seven years from the date of last entry. If the patient was under the age of 18 at the date of last entry, records must be securely stored until the patient turns 25.

If you work in a state or territory without specific legislation, it's recommended to use the ACT, NSW and Victorian requirements as a guide and securely store records for the same minimum period.

The date of last entry means the date the patient was last provided with treatment by the physiotherapist.

If there has been a complaint that may relate to an insurance claim or an Ahpra notification, you should keep the client record until the matter has closed. This may mean keeping the record for more than seven years. Use your judgement and contact your insurer if you have any queries.

Yes. Clinical records must be kept for participants in groups and classes, with sufficient notes on each patient’s file.

Notes must be accurate, securely stored and clinically justify the interventions provided to the client, as well as anything else of significance regarding the patient’s progress and clinical goals.

A physiotherapist is required to keep accurate clinical records. The Physiotherapy Board of Australia’s Code of Conduct sets out the requirements.

The APA can contact a member to remind them of their obligations. You can also notify Ahpra, or the Health Care Complaints Commission (HCCC) in NSW, or the Office of the Health Ombudsman (OHO) in Queensland, to discuss whether it is a matter they should investigate.

The Australian Privacy Principles and other state and territory legislation regulate information gathered and held by organisations, and Australian Government (and Norfolk Island Government) agencies.

The Privacy Principles require you to provide access to a patient’s health information without unreasonable delay or expense, as well as providing access to the information in the manner requested by the patient, if it is reasonable and practicable to do so.

If medical records are held by a private sector organisation, like a physiotherapist in private practice or by a private hospital, as a general rule, patients have a right to gain access to all the information held about them. If the clinical records are held by a Commonwealth agency, patients also have a right to access those records, unless the agency is required or authorised to refuse access to that information under the Freedom of Information Act 1982 or other Commonwealth legislation.

A patient may:

• look over the records
• take a copy of those records
• have them explained
• correct the information, if it is wrong.

There are some limitations on the right of access. These may apply:

• where providing access would pose a serious threat to the health and safety of any person
• where refusing access is required by law.

You are not required to charge a patient for access to their record and you should consider whether it is reasonable, fair or good service in the circumstances.

The Australian Privacy Principles state that you may charge for providing a patient access to their records, unless you are a government agency. The charge must be reasonable. You must not charge someone for asking for their records or for correcting information. However, state and territory legislation may differ. For example, Victoria and ACT set a maximum fee. In all cases, any fee should be reasonable.

You may charge companies, including lawyers, when providing copies of patient records. Before providing a copy of the patient record, you should contact the third party who requested the records to discuss what you intend to charge. Some government entities, or organisations where you may have a contractual obligation to provide information, like insurance companies, can legitimately refuse to pay.

You should obtain written consent from the patient before providing a copy of their records to the third party. You must ensure the patient's consent is recent and they know what they are consenting to. For example, has the third party requested a complete copy of the patient’s records or has the third party requested documents related to a certain injury or condition?

The third party should provide sufficient notice to allow you to obtain the patient’s consent.

The patient has the right to refuse their consent, but in doing so, must accept the risk that the third party (for example a private health or workers compensation insurer) may refuse to pay for a service.

A Court of Law or the police can issue a subpoena for you to produce a copy of patients’ clinical records. A subpoena is a legal document that you must comply with. For example, you may be subpoenaed to produce a copy of a patient's clinical records 'from 15 July 2013 to 12 May 2014 only'.

If you receive a subpoena, it's recommended you review the document thoroughly.

If any information is not accurately reflected such as the patient's details, advise the requesting representative to verify, amend and resubmit request to ensure all requirements are met. Additionally, you may obtain legal advice before complying. Insured APA members can access legal counsel by contacting our insurance provider via email at apa@bmsgroup.com or by phone on 1800 931 068.

The court does not pay witnesses for pre-trial phone conferences or for attendance as an expert witness.

However, you are entitled to be compensated for costs and loss of earnings which you have incurred as a result of attending court. You should discuss compensation in advance with the person or lawyer who has called you to give evidence.

According to the Federal Court, you may be compensated for:

• any cost of travelling to and from the court
• the cost of overnight accommodation (if necessary)
• a reasonable amount to compensate you for any wages or income you may lose when you attend the court
• if you are an expert witness, payment for the time you have spent preparing a report.

While the patient records belong to the practice, a patient has a right to see their record and can request their record, or a copy, be transferred to another practitioner without unreasonable delay.

Patient records do not belong to individual practitioners within a practice, unless there are contractual arrangements in place to this effect. Physiotherapists cannot take patient records after ceasing employment, unless explicitly stated in their employment contract. In scenarios where the physiotherapist brought patient records to a practice, they should negotiate an agreement with the practice that allows for the physiotherapist to take these records when ceasing employment and have a written contract to this effect.

Physiotherapists can charge per hour when writing a report to a solicitor or compensable organisation. Charges should be reasonable. Physiotherapists should discuss their fees or compensation in advance with the person or organisation that has requested the report. Some organisations may have fixed amounts for compensation. Some authorities, like a court, may require a physiotherapist by law to provide evidence and not provide any compensation.