NDIS Audit

Provider update: The NDIS is increasing audit activity – what you need to know

The NDIS has committed to improving funding value for money, while ensuring that the money paid is for services that occurred, and are within the pricing arrangements and limits.

What this means is that we should expect further scrutiny when the NDIS Compliance Response Team (CRT) conducts claim reviews for payments that appear ‘unusual’ in the context of the NDIS Pricing Arrangements and Price Limits, and participants’ plans.

In the case of an ‘unusual’ review, the CRT looks for things that don’t add up.

For example, charging 36 hours of daytime support work in one day, or an OT report which costs exactly $1,500 (even though the hourly rate is $193.99) are likely to raise suspicion.

Why should providers care?

Being aware of this change is very important. That’s because the reviews carried out by the CRT place the onus on the provider to prove the claim is compliant and can result in a claim or payment being rejected.

If the information provided is deemed insufficient, the CRT will retrospectively reject a payment that has been paid to a provider, either directly for agency-managed funds, or via a plan manager.

Our experience regarding such reviews is that they occur 6 -12 months after the payment has been made. So, at a minimum, you will need to go back over old invoices, timesheets, and notes for the past year to justify your claim. At worst, there may be a need to pay back the money received.

What can you do?

It’s not unusual to find that a shift was billed for when someone was sick, or someone accidentally billed $1,000 instead of $100. However, being clear, detailed and specific is important to ensure that you don’t lose your income. By invoicing accurately, with the right information, you’ll minimise the chances of running into trouble down the line.

As such here are some tips, based on our experience, to ensure you’re invoices don’t fall into the ‘unusual’ category:

  • You can’t bill in the future; Remember, the work being invoiced must be already completed. If you have an appointment booked for this afternoon, wait until you have done the work, even if you later have to claim for cancellation. (98% of invoices received by myAutonomy are processed on the same day, and paid within 2 days, so you won’t be out of pocket for long)
  • Break down the hours; Be clear about the services on a given day and date range. Avoid putting large numbers of hours in without any dates. Being clear, detailed and specific helps explain what you are invoicing to the NDIA avoiding confusion.
  • Clarify multiple workers; Where more than one worker is providing services on the same day at the same time, make it clear that care was a 2:1 ratio. Otherwise, the NDIS may question why you provided 24 hours of daytime services in one day.
  • Charge the NDIS hourly rate for NDIS service; You can only be paid for the maximum approved rate, per hour, per service. For example, if your ordinary hourly rate is $240, but the NDIS rate is $193.99, you should avoid invoicing 1.237hrs to make up the difference.
  • Include service codes; If you know the codes for the services provided list them on the invoice. That way we can ensure payments are in line with your service agreement if you have one. Also, if you supply a copy of your service agreement, we can reserve funds to reduce the chance of unpaid invoices.
  • Include specific dates/ days; Saturday, Sundays, and public holidays are paid at higher rates. If you send a bill for a week, fortnight or month, itemise the date/ days and rates, the services were provided, to ensure you’re paid at the correct rate.
  • Send invoices regularly; We know keeping up with invoicing can be hard, but you deserve to get paid for what you do. To get paid regularly and accurately, it’s essential to send in regular invoices. Sending invoices months after you provided the service increases the chance there won’t be any money left to pay you.
  • Review the NDIS guidelines; This article is useful for understanding what is and isn’t appropriate for invoicing.

How myAutonomy works with you to protect your hard-earned money

To ensure you get paid, we may ask for more details about an invoice. Our goal is to ensure the information held will satisfy the questions from the CTR and, ultimately, keep the money in your pocket. To make the process simpler, we’ve also created this invoice generator template, which can help if you don’t have access to invoicing tools or bookkeeping software already. Please ensure to read our easy to follow instructions here.

While it may seem challenging to provide more detailed invoices, it’ll actually save you time and money in the long run.

We’re here to help

At myAutonomy, we’re committed to helping everyone in the NDIS sector to better meet their goals. Have a question? We’re on hand to offer you assistance. Contact us on 1300 60 33 89 or at [email protected]