clinical services - acc · clinical services – operational guidelines . page . 3. of . 20. 1....
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This is living document and will be updated as required; the latest version is available on https://www.acc.co.nz/for-provider
Clinical Services Operational Guidelines
For Sports and Exercise Medicine Effective 1 July 2020
Clinical Services Sports and Exercise - Operational Guidelines
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Contents
1. Useful contacts and telephone numbers ......................................................................................... 3
2. About these guidelines..................................................................................................................... 4
3. Introduction ...................................................................................................................................... 4
4. Who can hold this contract .............................................................................................................. 4
5. Registrars ......................................................................................................................................... 4
6. Referral Process .............................................................................................................................. 5
7. Telehealth ........................................................................................................................................ 6
8. General Assessments ...................................................................................................................... 6
8.1. Consultations........................................................................................................................... 6
8.2. Initial assessments .................................................................................................................. 7
8.3. Subsequent consultations ....................................................................................................... 7
8.4. Second opinion assessments ................................................................................................. 8
8.5. Reassessment after 12 Months – CS500 ............................................................................... 8
9. Change of diagnosis and CSARTP Processes ............................................................................... 9
10. Pain Management diagnosis and procedures ............................................................................. 9
11. Medical Case Reviews and Medical Single Discipline Assessments ....................................... 11
11.1. Referrals for Medical Case Reviews and Medical Single Discipline Assessments .............. 11
11.2. Declining a referral ................................................................................................................ 11
11.3. Medical Case Reviews .......................................................................................................... 12
11.4. Medical Single Discipline Assessments ................................................................................ 12
11.5. Reporting requirements for MCR and Medical SDAs ........................................................... 12
11.6. Timeframes for submitting MCRs/Medical SDAs .................................................................. 14
11.7. Prioritising referrals ............................................................................................................... 14
11.8. “Out of Town” Clinics ............................................................................................................. 14
12. Service Monitoring ...................................................................................................................... 2
12.1. How will performance be monitored? ...................................................................................... 2
13. How do I get paid? ...................................................................................................................... 2
Appendix I ............................................................................................................................................... 3
Appendix II .............................................................................................................................................. 4
Appendix III ............................................................................................................................................. 5
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1. Useful contacts and telephone numbers
Information Sources Operational Queries These Operational Guidelines can be found on the ACC website.
Your ACC Pānui This quarterly publication updates Suppliers, Providers and Vendors on what’s happening across ACC’s business.
https://www.acc.co.nz/about-us/updates-from-us/provider-updates/your-acc-panui-a-quarterly-update-for-acc-providers/
ACC Provider Helpline Ph: 0800 222 070 Email: [email protected]
ACC Client/Patient Helpline Ph: 0800 101 996
ACC Provider registration Ph: 04 560 5211 Email: [email protected]
Fax: 04 560 5213 Post: ACC, PO Box 30 823,
Lower Hutt 5040
ACC eBusiness Ph: 0800 222 994,
option 1
Email: [email protected]
Health Procurement If you have a question about your contract or need to update your details, please contact the ACC Health Procurement team:
Email: [email protected]
Ph: 0800 400 503
Engagement and Performance managers
Engagement and Performance managers can help you to provide the services outlined in your contract. Contact the Provider Helpline or acc.co.nz /for providers for details of the Supplier manager in your region.
ACC Portfolio Contact the Provider Helpline for details of the Advisor/Manager for Secondary and Tertiary Care.
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2. About these guidelines
This is a guideline to assist the implementation of the Clinical Services - Sports and Exercise Service Schedule (also referred to here as “the contract”).
Read this guide in conjunction with the Contract and the ACC Standard Terms and Conditions.
Services must comply with the Clinical Services Service Schedule. Where there are any inconsistencies between this document and the Service Schedule, the Service Schedule takes precedence.
ACC will tell you when a new version of this guide is available on the ACC website at www.acc.co.nz.The guidelines can also be found under “Contracts” in the Resources area of the ACC website.
3. Introduction The purpose of the Sports and Exercise version of the Clinical Services is to fund:
• specialist assessment and treatment services
• recommendations for onward investigations, non-surgical treatment and rehabilitation.
• various medical assessments in relation to determining diagnosis/es, causation, and/or treatment and rehabilitation recommendations.
To ensure that all specialists are aware of the process for funding assessments, the services are clearly outlined in this document. ACC supports best practice for the assessment of all clients.
The information in this document is tailored to cover all sports and exercise physicians.
4. Who can hold this contract The contract holder (the supplier) is any Sport and Exercise Physician who is a Fellow of the Australasian College of Sport and Exercise Physicians or a physician operating under a limited scope of practice issued by the Medical Council of New Zealand and who is supported by the Australasian College of Sport and Exercise Physicians.
Any contract holder who is not an individual must notify ACC of the individuals who will be Named Providers providing service under the contract. A specialist can be named on more than one Clinical Services contract, e.g. if they work in both public and private hospitals. The supplier is responsible for managing the contract and disseminating information to the named providers.
This Clinical Services contract version covers specialist assessment in the skill area of sports and exercise. Services must not be provided at a higher level of expertise than needed. While this applies to all services and is aimed at promoting appropriate delegation of tasks within the wider health care team, it is particularly important if multiple providers work within the same premises.
5. Registrars The registrar training pilot is coming to an end from 1 July 2020 meaning that registrar activities are no longer part of the Clinical Services Sports and Exercise Medicine contract.
Registrars who are currently providing services under this contract are able to continue their training and complete their academic year. For the period 1 July 2020 to 31 January 2021 these Registrars can continue to provide services under the supervision of the contract holder and in compliance with
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the requirements of the Clinical Services Sports and Exercise Medicine contract. These Registrars will invoice against their own ACC provider names and numbers using the service items found in Table 1 (these codes will not be available beyond 31 January 2021). The contract code for registrar services will be: CLSNCSER.
Table 1: Registrar Service Items
Service Item Description CS21 Sports & Exercise Registrar: Initial Simple Assmt CS22 Sports & Exercise Registrar: Initial Complex Assmt CS63 Sports & Exercise Registrar: Subseq Simple Assmt CS64 Sports & Exercise Registrar: Subseq Complex Assmt CSEA Sports & Exercise Registrar: Moonboots CSEB Sports & Exercise Registrar: Simple Orthotics CSPA Sport & Exercise Reg: Ultrasound guided injection CSPB Sport & Ex Reg: Inj steroid &/or LA in joint/bursa CSTA Sports & Exercise Reg: Injections/joint aspiration CSTB Sports & Exercise Registrar: Complex injection CSTC Sports & Ex Reg: Plaster Cast/Splint below elbow
6. Referral Process Clients can be referred into this service by*:
• vocationally registered medical specialists
• general practitioners
• any other treatment provider as defined in the AC Act 2001 (eg physiotherapists)
• ACC
*The exceptions to this are referrals for Medical Case Reviews and Medical Single Discipline Assessments; these services can only be requested by ACC and require prior approval.
Referrals to a medical specialist under this contract from a primary care setting (integrated family health centre, medical centre or urgent care clinic) should only be made if the injury requires assessment or treatment that is within the scope of practice of the specialist and outside the scope of practice of the primary care provider.
Referrals for assessment and/or treatment will contain the following:
• client name
• ACC claim number
• date of injury
• injury diagnosis
• list of any previous known treatment and/or tests on this claim, and
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• the rationale for requesting the specialist’s opinion.
If the referral does not meet these criteria the Supplier can decline the request.
7. Telehealth Consultations may be undertaken by electronic means (Telehealth) where clinically appropriate. Telehealth consultations must meet the requirements and definitions outlined in the Medical Council of New Zealand (MCNZ) statement on Telehealth.
The current definition of Telehealth used by the MCNZ is ‘the use of information and video conferencing technologies, to deliver health services to patients and/or transmit health information regarding that patient between two or more locations at least one of which is within New Zealand’. This definition is considered to include telephone consultations.
Telehealth assessments should be conducted according to the same criteria for equivalent assessments completed face-to-face and use the same service items and rates (i.e. CS100, CS200, CS61, CS62)
Telehealth should not be used: • Where physical examination of the client is required (unless a physical examination has been
conducted on your behalf by another practitioner in the patient’s locality) • For Medical Case Reviews (MCR) and Single Discipline Assessments (SDA)
8. General Assessments General assessments are carried out by appropriately qualified medical practitioners who are registered with the Medical Council of New Zealand and who hold a vocational scope of practice and a valid Annual Practising Certificate.
In instances where the condition being treated is not believed to be causally related to an accident event, the provider should have a conversation with the Client regarding this and organise transfer of care to the public system or private health insurance as indicated (in liaison with their GP). It is ACC’s expectation that this occurs where the clinical picture is clear.
In some instances, clients can be seen for more than one claim on the same day. There can be a consultation billed for each claim provided they each have separate referral letters, appointment slots and reporting.
8.1. Consultations The specialist will ensure that the initial assessment takes place within 6 weeks of receiving the referral. If the specialist cannot meet this obligation, they must refer the client to another specialist who has capacity to meet this requirement.
Sports and Exercise Physicians who hold this contract may provide up to five consultations (no more than three of which may be complex consultations) and a referral for two high-technology imaging procedures (but only one per modality) per claim without seeking prior approval from ACC.
Note that we would consider 4 or 5 consultations to be unusual, and we consider that the most common frequency would be 2 to 3 consultations. Accordingly, consistent use of 5 consultations per claim would be noted and enquiries made, as it may indicate a client whose progress we need to be aware of. Note that these are totals per claim, not per specialist.
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If more than 5 consultations are expected, there should be a treatment plan in the clinical notes that details the expected rehabilitation outcome. This will be submitted to ACC by using the Clinical Services Assessment Report and Treatment Plan (CSARTP) at the back of this Guideline or following this link to the online document. This should be submitted as soon as it becomes apparent that more than 5 consultations will be required.
Providers can also order two high tech imaging procedures (one per modality). If more imaging is required, an ARTP must be submitted.
Clients will receive clinic-based procedures that do not need prior approval within 28 days of the assessment that determined the need for the procedure.
8.2. Initial assessments
Simple assessment (initial) - CS100
This is used when a specialist sees a client for the first time (first specialist assessment or FSA) to assess an injury. It can only be claimed once per specialist for that injury. Subsequent simple assessments fall under CS61.
Complex assessment (initial) - CS200
This assessment is done when a more complex level of investigation is needed, and a simple assessment will not be sufficient. It will take over 45 minutes to complete. This is direct client time and does not include report writing or reviewing scans and referrals when the client is not present. The increased time is justified in the clinical notes. It can only be claimed once per specialist for that injury. Subsequent complex assessments fall under CS62.
What should an initial assessment include? The provision of a treatment plan that outlines:
• Identification of causation (especially whether or not caused by an accident)
• identification of further diagnostic procedures if causation or the characteristics of the injury require further investigation
• expected duration for Clinical Services assessment and/or treatment
• anticipated treatment
• any referrals required
• the client’s capacity for return to normal function and/or employment.
8.3. Subsequent consultations Subsequent assessments are used for assessments or consultations where specialists discuss the results of tests or interventions with the client and explore the resulting treatment and rehabilitation options. It is also used to provide necessary on-going management and/or conservative treatment, or if the client has not reached the outcomes predicted in the initial ARTP and needs a subsequent assessment or consultation.
A subsequent assessment can either be Simple or Complex depending on clinical best practice and client complexity.
• CS61 - Simple subsequent assessment is expected to take up to 30 minutes
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• CS62 - Complex subsequent assessment is expected to take over 30 minutes. The increased time is justified in the clinical notes.
NOTE: A subsequent assessment may place on the same day as the initial assessment if an intervening event (such as imaging) has occurred to justify it.
If 5 or more subsequent assessments are expected a treatment plan must be submitted to ACC electronically at [email protected].
8.4. Second opinion assessments This assessment is done when a second opinion is needed from an anaesthetist or other specialist while a client is being assessed or diagnosed, and/or having their ongoing care options considered. A second opinion may be requested regardless of whether the initial assessment recommended surgical or non-surgical care. All vocational scopes of practice can refer for second opinions.
A second assessment can be either Simple or a Complex depending on clinical best practice and client complexity.
• CS400 - Simple second assessment is expected to take up to 45 minutes
• CS900 - Complex second assessment is expected to take over 45 minutes. The increased time is justified in the clinical notes.
This is direct client time and does not include report writing or reviewing scans and referrals when the client is not present.
Payments for second opinions
This type of assessment will be paid under:
• this agreement if the second specialist is a named specialist, or
• the appropriate regulations if the second specialist is not named in any current Clinical Services contract with ACC.
Overall responsibility for Clinical Services ARTP in the event of second opinions
The initial specialist remains responsible for providing the Clinical Services Assessment Report and Treatment Plan (ARTP) to ACC, and for including in it any recommendation made by the second specialist.
8.5. Reassessment after 12 Months – CS500
Reassessments are used for subsequent simple or complex assessments by the provider who carried out the initial assessment. The client must have been discharged from the care of the provider and a new referral is required before a reassessment can occur.
NOTE: Reassessments cannot occur within 12 months of the initial assessment.
Reassessments are distinguished from the CS61 and CS62 codes so that ACC can identify and report on lingering injuries.
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9. Change of diagnosis and CSARTP Processes A change in diagnosis may mean either that the provider has determined that the original diagnosis is no longer accurate or that the injury is not caused by an accident. If a provider needs to notify ACC that the original diagnosis by which cover was granted has changed, complete the online ACC32 form or send a copy to [email protected].
Receipt of this form by ACC is for the record only and does not automatically imply any further consideration of cover by ACC at that point. Further consideration of cover by ACC will be triggered by the CSARTP form.
The CSARTP form is used either when the cause of the injury is in doubt and the provider wishes ACC to confirm cover before proceeding, or when, in the provider’s clinical view, consultations or imaging beyond the preapproved limit of 5 consultations and 2 HTI referrals is required.
The CSARTP form should be completed to include a substantive statement of the prognosis for the client’s return to work or independence. The CSARTP can be accessed via this link.
The CSARTP form should be sent to [email protected]. We endeavour to reply by email to the provider with a decision within 6 to 12 days, but more complex cases may take longer. In addition, this is a new process for ACC, so we will be assessing volumes during the next 12 months.
ACC will not fund further treatment while an ARTP is pending, so if a follow-up consultation resulting from, for instance, HTI is required, it should occur before the CSARTP is sent, and be within the 5-consultation limit.
Checking on the approval process
For information on where the approval process is up to, contact the ACC Provider Helpline 0800 222 070.
10. Pain Management diagnosis and procedures The Clinical Services Contract has been aligned with the Pain Management Contract to provide more efficient and timely access to diagnosis and treatment for clients who have an ACC covered injury and are experiencing pain.
These interventions are funded for clients whose complexity does not warrant referral to the Pain Management Service. For such clients who do not have chronic pain (measured by the OREBRO score) the referral pathway would be through clinical services for diagnosis and treatment. New codes have been developed for these diagnostic and treatment procedures.
Certain image-guided injection procedures may be performed by the provider where their scope of practice permits. For ultrasound-guided injections (including joints, bursa or other soft-tissue structure), for instance, the code CSP7 may be used. If a radiologist is required to perform an image-guided injection procedure, this would constitute a referral under the radiologist’s High-Tech Imaging contract.
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Service Item Code Service Description Approval requirements
CSP1 Transforaminal injection steroid (always with image intensifier) and/or local anaesthetic
One pre-approved, 2nd and subsequent require an ARTP
CSP2 Lumbar epidural steroid with or without local anaesthetic
CSP3 Lumbar epidural steroid with or without local anaesthetic with imaging
CSP4 Caudal injection steroid with or without local anaesthetic
CSP5 Caudal injection steroid with or without local anaesthetic, with imaging
CSP6 Simple injection of steroid and/or local anaesthetic into joint or bursa (hand, foot, elbow, shoulder, knee)
CSP7 Injection of steroid and/or local anaesthetic into joint under imaging (excluding ultrasound)
CSP8 Injection of anaesthetic agent around peripheral nerves
CSP9 Injection of anaesthetic agent around nerve using image intensifier or EMG
CSP10 Injection of anaesthetic agent around the Sciatic nerve, using image intensifier or EMG
CSP11 Sacro iliac injection (steroid and/or local anaesthetic)
CSP12 Lateral atlantoaxial injection steroid and/or local anaesthetic under imaging
CSP13 Complex injection of steroid or local anaesthetic agent into hip joint with imaging
CSP14 Injection of steroid and/or local anaesthetic into joint under ultrasound.
Note: Some procedures include specialist time for the administration of the procedure so cannot be invoiced in conjunction with consultation cost. Detail of this can be found in the service schedule.
Prior Approval
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To request prior approval for a second and subsequent injection please complete the Clinical Services ARTP form and sent it along with all supporting documentation to TAC via [email protected]
The Clinical Services Contract still retains the following codes to be used for non-image-guided injections:
CST4 Injections or Joint Aspiration
CST5 Isolated Nerve Block
CST6 Regional block (not LA) or compartment pressure monitoring
CST10 Complex injection
Clients who have chronic pain and require intervention through a multidisciplinary team approach should be referred through the Pain Management contract.
A specialist will refer to the appropriate provider for the necessary procedure where the provider’s scope of practice requires.
11. Medical Case Reviews and Medical Single Discipline Assessments
Medical Case Reviews and Medical Single Discipline Assessments are initiated by ACC and are used to obtain an opinion from a non-treating practitioner who is a medical specialist, when ACC is unable to get this from a treating practitioner. The provider (specialist) completing a Medical Case Review or Medical Single Discipline Assessments is able to order tests or investigations if this is necessary for them to be able to come to an opinion. They can also make recommendations for tests or investigations.
11.1. Referrals for Medical Case Reviews and Medical Single Discipline Assessments
Referrals for Medical Case Reviews and Medical Single Discipline Assessments may only be made by ACC.
11.2. Declining a referral The provider may decline a referral if:
• they cannot meet timeframes as set out under Clause 7.1.2 within the Service Schedule
• they do not have an appropriate medical specialist available in relation to the injury
• they consider that the referral is more appropriately managed under the Vocational Medical Services contract because:
1) it includes consideration of a client’s employment as a major factor of the assessments;
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2) an assessment by an occupational medicine specialist of work restrictions, limitations, fitness for work, the ability to engage in employment or the ability to participate in vocational rehabilitation is required.
The provider must notify the referrer if the referral is declined.
11.3. Medical Case Reviews A Medical Case Review (MCR) is initiated by ACC and is used to obtain clarity about diagnosis/es and assessment of causation together with recommendations for further investigations, treatment or rehabilitation. An MCR can be used to help determine cover and ongoing entitlements. MCRs can be purchased as either Standard or Complex, taking into account the complexity of the Client’s presentation.
• CSM1 – A Standard Medical Case Review is expected to take up to 3.5 hours.
• CSM2 – A Complex Medical Case Review is expected to take more than 3.5 hours and less than 7.5 hours, as the Client’s injury is of unusual complexity or there are co-morbidities that appear to be affecting the Client’s recovery from injury; or the MCR will be undertaken in two parts whilst results of investigations are obtained.
Exceptional Medical Case Reviews
In rare cases where an MCR requires more than 7.5 hours, ACC may request the provider to undertake an Exceptional MCR. If on referral, the service provider believes the Client is exceptionally complex over and above the cost available under the Complex category, please contact ACC to discuss.
A complete definition for MCR services purchased under the Clinical Services contract is set out within the Services Schedule (Clause 7.2.4. to 7.2.6).
11.4. Medical Single Discipline Assessments
A Medical Single Discipline Assessment (Medical SDA) is initiated by ACC and is used to obtain recommendations for the best onward treatment or rehabilitation. A Medical SDA cannot be used to determine cover and ongoing entitlements.
• CSA1 – A Standard Medical SDA is expected to take up to 2.5 hours.
• CSA2 – A Complex Medical SDA is expected to take more than 2.5 hours and less than 4.5 hours, as the Client’s injury is of unusual complexity or there are co-morbidities that appear to be affecting the Client’s recovery from injury; or the Medical SDA will be undertaken in two parts whilst results of investigations are obtained.
Exceptional Medical Single Discipline Assessments
In rare cases where a Medical SDA requires more than 4.5 hours, ACC may request the provider to undertake an Exceptional Medical SDA. If on referral, the service provider believes the Client is exceptionally complex over and above the cost available under the Complex category, please contact ACC to discuss.
A complete definition for Medical SDA services purchased under the Clinical Services contract is set out under Clause 7.2.7 within the Services Schedule.
11.5. Reporting requirements for MCR and Medical SDAs ACC’s expectations for each Medical Case Review and Medical Single Discipline Assessment report to include at least the following:
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• The Named Provider’s qualifications and statement of impartiality as a non-treating
practitioner;
• Any facts and assumptions on which the opinions and recommendations of the Named Provider are based;
• A summary of the clinical history and examination the Named Provider has completed;
• Clear recommendations;
• Reasons for the opinions and recommendations made by the Named Provider;
• References to any literature or other material used or relied on in support of the opinions and recommendations expressed; and
• A description of any examinations, tests or other investigations that have been relied on in support of the opinions and recommendations expressed.
In addition, MCRs must include:
• A statement on the mechanism of injury used to assess causation in the specific case. If this differs from that obtained by ACC (as expressed in the referral document) an explanation of the difference must be provided;
• A statement on general causation with explanatory rationale. General causation requires a recognition by the scientific community that the mechanism of injury could cause the diagnosis/es - this might be with reference to the peer-reviewed literature and/or a statement on biomechanical plausibility;
• A statement confirming whether or not the specific client and/or specific circumstances of this case would confer an exception to the general scientific understanding. If this is an exception, an explanatory rationale must be provided;
• A statement on specific causation with explanatory rationale. Specific causation requires an assessment as to whether the specified mechanism of injury caused the diagnosis/es in this particular case; and
• If there is evidence for general and specific causation, a statement as to why this explanation is considered more likely than alternative possible causes of the same condition, including it being idiopathic.
Where clarity about causation specific to a work-related gradual process, disease or infection is requested, statements as to the circumstances which caused the injury need to include:
• whether or not the personal circumstances of the client in relation to their employment led to exposure that caused the injury
• circumstances of the property or characteristics of employment or non-employment activities that caused or contributed to the injury
• the risk of the client suffering this injury compared to others in the workplace undertaking and not undertaking the same employment tasks and to others who are employed in that type of environment.
In addition, Medical SDA reports must include:
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• Specific recommendations for any further investigations, treatment and/or rehabilitation with explanatory rationale;
• Demonstration of clinical reasoning and a rationale for decisions reached.
11.6. Timeframes for submitting MCRs/Medical SDAs Providers who undertake an MCR or a Medical SDA are required to provide an MCR or Medical SDA report within eight business days of the Specialist completing a consultation. A detailed timeframe for submitting an MCR or Medical SDA is set out under Clause 7.1.2 of the Clinical Services Service Schedule.
11.7. Prioritising referrals Please keep in mind that referrals for MCRs will be used by ACC to help make decisions regarding ACC cover or entitlements which is a priority for ACC. Efforts by providers to prioritise MCRs are appreciated. Should a provider have spare clinics or capacity to see clients for MCRs, please make sure this is brought to ACC’s attention.
11.8. “Out of Town” Clinics ACC may make arrangements with a provider to visit a region (outside of the provider’s area of domicile) to undertake a clinic. Where the clinic is in association with the Vocational Medical Services contract, travel and accommodation should be charged under the Vocational Medical Services contract. The ACC Branch will work with the provider to ensure arrangements are made for booking clients and meeting costs that are in addition to those available under the Clinical Services contract. This includes clinic room hire, travel, travel time and accommodation as appropriate.
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12. Service Monitoring
12.1. How will performance be monitored?
Service monitoring for this service is based on an outlier approach by comparing supplier billing data, across a number of metrics, with those of their peers. The purpose of the monitoring is to understand how our suppliers operate, to ensure that suppliers adhere to Part B, Clause 2 of the service schedule, and identify performance issues where they might exist.
ACC will provide suppliers with their reports on a six-monthly basis; these reports will include (but is not limited to):
• General claim data (spend, volume, claim count, average consults per claim) • Complex vs. simple initial and subsequent assessments • The use of reassessment codes • Neurology assessments • Medical case reviews, single discipline assessments and DNA codes – ratios of simple,
complex and exceptional • Exception reporting for consultations invoiced within the 6-week post elective surgery
discharge period • Exception reporting for reassessment codes invoiced within 12 months of a consultation
Suppliers might be asked to meet with their Engagement and Performance Manager to discuss their data and any outlier results. If the service monitoring identifies performance issues your Engagement and Performance Manager will work with you on a resolution.
13. How do I get paid?
Payment will only be made for services provided by the contract holder (if an individual) or by named providers on the contract.
ACC’s method of invoicing for services is electronic billing which makes the process faster, easier, and more efficient. Instructions on how to send in invoices electronically can be found on the ACC website.
The payment will be made to the supplier who holds the contract. If you are a provider named on a supplier’s contract you will need to discuss with the supplier how they will forward the payment to you.
Work performed by Registrars in the scope of Sports and Exercise Medicine must be invoiced by their named Supervisor. This is to ensure that clinical accountability for the Registrar’s work is clear to ACC.
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Appendix I
Frequently asked questions (FAQs) about Clinical Services
1. What is a simple initial assessment?
As a general guide a simple assessment is an initial assessment that takes less than 45 minutes. This can only be used once per claim for each specialist. A more detailed description can be found in Clause 8.1.1 of the contract.
2. What is a complex initial assessment?
A complex assessment is an initial assessment that takes over 45 minutes to complete. This can only be used once per claim for each specialist. A more detailed description can be found in Clause 8.1.1 of the contract.
3. Can I charge a co-payment?
No. The price for each clinical service is the amount chargeable and no additional amount may be charged.
4. Where do I send the ARTP?
All clinical services ARTPs are sent to [email protected].
5. How do I find out more information on sending my invoices electronically?
Please contact the e-business team 0800 222 994 (option 1), or email [email protected].
6. The treatment I need to provide is not listed in this contract. What can I do?
Additional intervention assessments are available. Many of these need prior approval by ACC, therefore it is best to contact ACC client’s Case Manager to discuss this. If the patient does not have a client service staff member managing their case, contact Provider Help on 0800 222 070
7. My patient does not have a case owner and needs more help from ACC. Who do I contact?
Contact Provider Help on 0800 222 070
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Appendix II
Frequently asked questions (FAQs) on Medical Case Reviews and Medical Single Discipline Assessments
Q Can a General Practitioner refer directly for a MCR or Medical SDA?
A No. A specialist can accept a referral for a first or subsequent specialist appointment under the Clinical Services Contract from a GP, but not for a MCR or Medical SDA.
Q How will outliers be managed for MCR referrals (i.e. rare cases which take for example 16 hours to complete the review)?
A There is an exceptional process available which is negotiated on a case by case basis with the ACC case owner.
Q Can I continue to provide MCRs and Medical SDAs outside of the Clinical Services Contract?
A Frequent providers of MCRs and Medical SDAs will need to hold the Clinical Services Contract. An individual Letter of Agreement may rarely be used. The terms and conditions and price paid when a letter of agreement is used are the same as the Clinical Services Contract.
Q Does Clause 4.2.4(c) of the Clinical Services Contract mean referrals to occupational physicians should be re-directed to the Vocational Medical Services contract?
A No, this clause means that where a medical specialist receives a referral they think would be more appropriately managed under the Vocational Medical Services contract, they have the option to decline the referral. Occupational physicians are included in the Clinical Services Contract. This means occupational physicians should accept referrals for MCRs where the primary reason for referral relates to diagnosis or causation; and should accept referrals for Medical SDAs where the primary reason for the referral is to provide advice on onward treatment or rehabilitation. In cases where diagnosis or injury cause is not in question; and the client is no longer employed; and a rehabilitation plan needs to be developed requiring an occupational physician’s expertise, this is more appropriately referred under the Vocational Medical Services contract.
Q I cannot not see any provision for payment of travel related costs in this Clinical Services contract. Occupational Medicine Specialists currently travel to provincial areas to conduct MCR & Medical SDA assessments where there is no such resident specialist. Please advise.
A Travel and accommodation costs are not able to be charged under the Clinical Services Contract. However, ACC can approve travel and accommodation costs to be paid separately where they have requested a clinic be held in their province. In this situation, the actual delivery of the MCR or Medical SDA services is paid under the Clinical Services contract and travel and accommodation costs is invoiced separately as instructed by the ACC referrer.
Q If I am asked to undertake a clinic out of region to complete MCRs and Medical SDAs for ACC, how is travel, accommodation and clinic fees reimbursed as there is no provision in the Clinical Services Contract?
A If ACC requests that you undertake a clinic out of region, then there are provisions available for travel, accommodation and clinic room hire which are paid separately to the Clinical Services Contract. There is a set fee available for accommodation and other expenses incurred for clinic room hire and travel incurred at cost.
Appendix III
Clinical Services Assessment Report and Treatment Plan (CSARTP)
Te Kaporeihana Āwhlna Hunga Whara
Please complete the form and sign the declaration. Keep this form for your records and send a copy along with any
supporting documents to ACC as follows:
• Prior approvals requests: [email protected]
• All other CSARTPs: [email protected]
Please tick box to indicate if this is an:
Initial Plan Updated plan Prior Approval request
1. ACC DETAILS This form was completed on [date]
Email address:
2. SUPPLIER DETAILS
Supplier name: Supplier number:
Specialist's name: Date of consultation:
Specialist Email address:
3. CLIENT DETAILS
Client's full name:
ACC Claim number:
4. CONSULTATION DETAILS
Injury details (including
date and history of the
injury, the initial and
current diagnosis, and
relevant medical history)
5. TREATMENT RECOMMENDED
ACC procedure code
ACC procedure name
Date of proposed treatment
Activity modification (eg
light duties)
Proposed plan
Review date (anticipated or
known)
6. ATTACHMENTS
Please list and attach copies of any documents that support your recommendations
7. SPECIALIST DECLARATION
I certify that, on the date shown, I personally examined and/or treated the client. I have discussed their treatment
options with them and advised why the recommendation is the appropriate treatment in this case. The client (or their
representative) has authorised me to provide this information to ACC on their behalf.
Signature: Date:
Specialist name:
The information collected on this form will only be used to fulfil the requirements of the Accident Compensation Act
2001. In the collection, use and storage of information, ACC will at all times comply with the obligations of the Privacy
Act 1993 and the Health Information Privacy Code.