PRO RATA BILLING ARRANGEMENTS CONTRARY TO PRICE GUIDE RULES
This week a DIA member raised concerns after identifying pro rata instalment billing agreements for Coordination of Support (CoS) funding occurring, contrary to the NDIS Price Guide Rules.
The identified provider is reportedly dividing total CoS funds by the length of a participants plan, and billing this pro rata amount automatically whether or not service was provided. Service agreements in place have general CoS arrangements stipulating the provider is responsible for CoS while the service agreement remains current, combining phone calls, emails, face to face and non face to face billed service.
While the provider asserts that the NDIS approves of this ‘standard’ practice, the NDIS Price Guide clearly articulates the following for provider compliance:
- Providers can only make a claim for payment for a support once that support has been delivered or provided;
- Providers are responsible for ensuring that the claims for payment that they made accurately reflect the supports delivered;
- Claims need to be made against the specific support item that aligns with the service delivered; and
- Falsifying claims for payment is a serious compliance issue and may result in action against the provider. Providers are required to keep accurate records of claims, which are subject to audit.
An NDIS relationship manager has confirmed that providers cannot auto claim based on a pro rata amount, as they would be claiming for a service that did not occur. At audit, providers will have to show proof that service did go ahead to be compliant.
DIA would like to ensure that all our members are reminded of the payment claiming rules, and for participants who are Agency or Plan Managed, encourage you to refer back to the latest Price Guide 2020-21, valid from 1st December 2020, for latest rules and guidelines.