Exercise physiology services policy

Who can provide exercise physiology services?

The WorkSafe Agent (the agent) can only pay the reasonable costs for exercise physiology services provided by healthcare professionals who are:

• registered by WorkSafe to provide exercise physiology services
• fully accredited members of Exercise and Sports Science Australia
• able to provide evidence of current professional indemnity insurance

Further information on WorkSafe's required level of professional indemnity insurance can be found on:

WorkSafe expectations for the delivery of exercise physiology services

WorkSafe expects that all exercise physiologists providing services to workers as part of the Victorian Workers' Compensation Scheme integrate the principles of the Clinical Framework for the Delivery of Health Services (Clinical Framework) into their daily practice.

The Clinical Framework is based on the following principles:

• measure and demonstrate the effectiveness of treatment
• adopt a biopsychosocial approach
• empower the injured worker to manage their injury
• implement goals focused on optimising function, participation and return to work
• base treatments on best available research evidence

Referral requirements

• A medical practitioner must provide a referral for exercise physiology services prior to commencement of treatment.
  • Referred services include all approved health services with the exception of medical, chiropractic, physiotherapy, osteopathic, optometry, dental and podiatry services.
• No referral to other health services:
  • WorkSafe does not allow exercise physiologists to provide referrals to other health services.

Allied Health Recovery Management Plan

If treatment by an exercise physiologist is going to continue beyond five (5) sessions, an Allied Health Recovery Management Plan (AHRMP) must be completed and submitted to the managing agent.

This plan must be completed in full by the allied health practitioner and submitted to the agent by the 5th consultation.

Return to Work Case Conferencing

WorkSafe registered exercise physiologists are expected to communicate and collaborate with other parties involved in the worker's support team to facilitate continuity of care and return to work.

Return to Work Case Conferences (RTWCC) bring together the worker, referring medical practitioner, employer, WorkSafe agent, occupational rehabilitation provider, and other relevant parties. They can be used to discuss the worker's capacity, any barriers affecting recovery, set goals, and agree on timeframes for recovery at/return to work.

Typically, a RTW case conference will be requested by an agent or the occupational rehabilitation consultant however, a treating health practitioner can request a case conference by contacting the agent or the occupational rehabilitation consultant directly. RTWCCs will be remunerated as outlined in the exercise physiology fee schedule.

How much can the agent pay?

The agent can pay the reasonable costs of exercise physiology services up to the maximum amount as detailed in WorkSafe's Exercise Physiology Services Fee Schedule.

Guidelines

The agent can pay the reasonable costs of exercise physiology services that meet all of the following criteria:

• treatment is for a work-related injury or illness
• the provider is currently registered as an exercise physiologist with WorkSafe
• a medical practitioner has provided a referral for treatment
• the service is in line with the principles of the Clinical Framework
• the treatment is safe and effective
• treatment does not become part of general well-being once rehabilitation has been completed

The agent will periodically review an injured worker's entitlement to exercise physiology services to ensure the treatment and services remain reasonable for the work related injury and/or illness and are payable under the legislation.

Restricted consultations

Recognising that certain injuries and conditions require extended consultations, WorkSafe has a process in place to ensure severely injured workers and those with complex conditions can access the treatment they need. Extended consultations are referred to as restricted consultations, and require prior written approval.

Conditions where restricted consultations are likely to be required include, but are not limited to,

• moderate to severe acquired brain injury
• crush injuries
• extensive burns
• spinal cord injuries
• multiple orthopaedic fractures
• limb amputations

The Restricted Consultation application form must be completed by an exercise physiologist and submitted to the managing agent. If the injury meets the above criteria or is reasonable on merit, the agent forwards the application to the WorkSafe Clinical Panel for review and possible discussion with the provider. Exercise physiologists should not bill the restricted item consultation item number until they have been advised in writing that their application has been accepted.

Consultations in the community and travel

• The agent can pay the reasonable costs of a consultation undertaken in a community setting, such as at a hospital, at home or at an injured worker's workplace.
• To facilitate community-based consultations, travel is payable at the per kilometre rates specified in the Exercise Physiology fee schedule.
• The provider should discuss the requirement for community-based consultations and the associated travel with the agent and obtain written approval prior to invoicing travel items.
• The agent expects the injured worker to seek treatment from a provider in their local area. Please refer to the WorkSafe Exercise Physiology Fee Schedule for more information.
• Definitions for metropolitan and rural/regional are taken from Victorian Department of Health (DH) guidelines. For maps and further details visit health.vic

What the agent will not pay for

• treatment or services for a person other than the worker
• appointments where the worker cancels or does not attend
• telephone consultations or conversations, either to the worker or other related parties (such as the employer, WorkSafe or other healthcare professionals) unless these are occurring as part of an in-person consultation with the worker
• treatment or services provided by telephone or other non face to face mediums that do not align with WorkSafe's telehealth policy
• more than one exercise physiology consultation provided on the same day to the same worker services when an exercise physiologist is registered with WorkSafe for more than one allied health service (for example, exercise physiology and remedial massage), the agent will not pay for the provision of more than one service type to the worker on the same day
• treatment or services subcontracted to, or provided by a non-registered provider
• treatment or services provided by a health professional not registered and approved by WorkSafe under Victorian workers' compensation legislation

WorkSafe's invoice Requirements

Please refer to how to invoice WorkSafe guidelines. It is recommended that invoices be submitted on a regular basis to the relevant agent.

Suspension from providing services to WorkSafe clients

If WorkSafe gives notice to a provider advising them that they are suspended from providing services to WorkSafe clients, WorkSafe will notify their professional body and Medicare Australia of the suspension and the grounds on which the suspension has been issued.

For Further information

Contact the referring agent, email [email protected] or refer to: