🇦🇺Australia

Prior Approval Delays

1 verified sources

Definition

The Mechanism: Due to ACC and WorkSafe schedules, many vocational rehab services (e.g. VRS21, VRB13) require prior approval before payment. Delays in approval prevent timely invoicing.

Key Findings

  • Financial Impact: AUD 910.37 per Stay at Work One service if approval delayed beyond 10 days
  • Frequency: Per service requiring prior approval (max 1-3 per case)
  • Root Cause: Manual prior approval processes creating unbilled services

Why This Matters

Rehab providers in Australia lose AUD 910+ per delayed service from prior approval waits. Streamlined approval workflows capture full billable revenue.

Affected Stakeholders

Service coordinators, Billing staff

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Financial Impact

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Current Workarounds

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Methodology & Sources

Data collected via OSINT from regulatory filings, industry audits, and verified case studies.

Evidence Sources:

Related Business Risks

Outcome Timeline Bottlenecks

AUD 1,142.58 full fee lost if outcomes not achieved in 10 days (VRP01)

Billing Review Clawbacks

AUD thousands in overpayments clawed back per review (exact amounts case-specific)

Agreement Suspension Risks

100% revenue loss from WorkSafe during suspension period (AUD 910+ per service episode)

Fee Schedule Non-Compliance

AUD 209.35/hour rejected if wrong code; 10% fee increase clawback risk

Nicht abgerechnete Leistungen bei AT‑Assessments und Beschaffung

Quantified (logic-based): For a medium provider performing ~1,000 AT assessment/procurement episodes per year, if 5–10% of episodes involve 1–2 hours of assessment/procurement time that cannot be billed or is rejected (1.5 hours average at AUD 180/hour clinical rate), this equals 75–150 hours/year or AUD 13,500–27,000 in direct unbilled labour. Adding 1–2 large equipment orders per month written off due to funding ineligibility or missed prior approval (24 per year at average margin AUD 1,500) adds ~AUD 36,000/year. Total indicative revenue leakage: ~AUD 50,000–60,000 per site, or AUD 100,000–300,000 for multi‑site providers.

Überhöhte Beschaffungskosten und Lagerbestände bei Hilfsmitteln

Quantified (logic-based): For low‑cost AT (under AUD 1,500 per item) across a vocational rehab provider’s caseload, assume 1,000 items purchased annually at an average cost of AUD 500 each (AUD 500,000 total). If 10–20% of items are later found unsuitable, cannot be reused, or sit idle due to lack of loan/refurbish systems, this equates to AUD 50,000–100,000 in direct product wastage. Add 300–500 hours of clinician and admin time per year spent on repeated supplier quotes, ad‑hoc orders and stock management at blended AUD 80/hour (AUD 24,000–40,000). Combined cost overrun: approximately AUD 75,000–140,000 per medium provider, and AUD 150,000–500,000 for larger multi‑site operations.

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