Billing Guide

1. Purpose and scope

This policy applies to PBSG participants, their authorised representatives and payers, plan managers, support coordinators and PBSG workers involved in billing. It covers NDIS-funded, privately funded and other agreed services.

PBSG charges only for supports requested or authorised for the participant. The signed Service Agreement and the completed pricing and funding schedule—Schedule 3 where that numbering is used—record budgets, funding type, travel choices and payer details. The Service Agreement pre-agrees the maximum-applicable-NDIS-rate pricing formula for billable NDIS supports. Privately funded and other non-NDIS services use the rate stated in the agreement or pricing schedule.

Examples and any usual time ranges are guides only. They are not guaranteed quotes. The time needed can change with complexity, available records, risk, environments, the number of stakeholders and the work authorised.

How this policy fits your Service Agreement

PBSG service agreements refer to the policies and schedules that explain how services operate. This policy gives practical billing detail. Under the pre-agreed pricing formula in the Service Agreement, changes to the applicable NDIS maximum rate take effect automatically and prospectively from their effective date for billable NDIS supports; other participant-specific terms continue to be governed by the agreement, schedules and applicable law.

If you need a copy of your signed Service Agreement or want to discuss a participant-specific term, contact PBSG about your Service Agreement.

2. Core billing principles

• PBSG charges for time spent delivering agreed, participant-specific supports.
• Work must be reasonably necessary for the agreed service, within the practitioner’s role and permitted by the applicable funding and pricing rules.
• PBSG will not knowingly charge twice for the same time or activity.
• Where shared charging is permitted, time shared between participants or providers must be apportioned fairly.
• Routine business overheads and general administration are not separately charged unless a charge is expressly permitted, directly related to the participant and agreed.
• Itemised invoices should let the payer understand the date, support, duration, rate, travel and any other charge.
• You may ask questions, request an explanation or raise a billing dispute without being treated adversely.

3. Prices and NDIS price limits

The Service Agreement pre-agrees the pricing formula for NDIS supports. For every support billable under the NDIS and the Service Agreement, PBSG charges the maximum applicable NDIS rate in force when the support is delivered. That maximum always applies automatically and prospectively from its effective date, including when the NDIA changes a support item, description, rule or maximum price. PBSG will not charge more than the applicable NDIS limit.

The NDIA may change support item numbers, descriptions, rules and maximum prices. The official NDIS pricing arrangements page is the source for current documents and updates; this policy does not copy rates that can become outdated.

The maximum applicable NDIS rate always applies to billable NDIS supports under the Service Agreement.

For privately funded or other non-NDIS services, PBSG charges the rate stated in the signed agreement or pricing schedule. Any charge remains subject to applicable law and rights that cannot lawfully be excluded.

4. Direct supports

Direct supports may be billed where they are agreed, clinically appropriate and permitted. They may include:

• face-to-face sessions with the participant
• sessions at home, school, a workplace or in the community
• telehealth and telephone sessions
• observation, interviews and assessment
• behaviour support implementation activities
• coaching or training for the participant’s support network
• meetings and case conferences that form part of the participant’s support
• urgent participant-specific clinical work that PBSG has agreed to provide

A session duration may include agreed participant-specific activities completed immediately before or after the participant-facing component when they form part of the same support. Invoices must remain understandable and must not use a direct-support label to conceal non-face-to-face work.

5. Non-face-to-face and indirect supports

Behaviour support involves work completed for a participant when the participant is not present. That work is not automatically billable. It must be participant-specific, reasonably necessary, proportionate, permitted by the applicable rules and covered by the agreed service arrangement.

Subject to those boundaries, billable work may include:

• preparing for a session or meeting
• reviewing referral information, behaviour data, incident reports, relevant health or allied health records, education records, previous plans and other relevant documents
• case formulation, clinical planning and functional behaviour assessment work
• analysing participant data and producing participant-specific graphs or summaries
• drafting, reviewing and updating interim or comprehensive behaviour support plans
• risk assessment, safety planning and crisis-prevention planning within PBSG’s scope
• restrictive-practice assessment, consultation, documentation and review where PBSG is engaged and authorised to do that work
• participant-specific letters, recommendations, progress reports, review reports, evidence and funding applications
• participant-specific visual supports, training materials and implementation resources
• liaison with authorised family, carers, nominees, support coordinators, plan managers, schools, providers, health professionals, the NDIA or the NDIS Commission
• reading and responding to substantive participant-specific emails, messages and documents
• participant-specific telephone calls, video calls and stakeholder meetings
• clinical consultation, supervision or peer review reasonably necessary for the participant’s care, limited to the time and information reasonably required
• file notes and clinical documentation needed to record the support delivered
• follow-up arising from a session, incident, assessment, meeting or plan
• participant-specific research needed to address an unusual clinical issue

Not every email, note or internal conversation is billable. PBSG applies the same test each time: is the work participant-specific, reasonably necessary, permitted, proportionate and agreed?

6. Behaviour support assessments, plans and reports

Assessment, plan and report work usually involves several components, not only a final writing session.

The time needed varies with complexity, records, stakeholders, risk, data quality, restrictive practices, urgency and revision requests. A guide is not a quote.

You may request an estimate or ask PBSG to expressly agree to a budget cap before substantial work begins. An estimate or typical range is not a quote or cap unless PBSG expressly says so. PBSG must obtain further approval before exceeding an expressly agreed cap unless immediate work is reasonably required for safety or legal compliance. If that exception applies, PBSG should communicate as soon as practicable.

7. Communications, meetings and stakeholder liaison

Participant-specific communications may include:

• emails, telephone calls, SMS or secure messages
• video meetings and case conferences
• provider, school, hospital or health-service meetings
• communication with the NDIA, a plan manager or a support coordinator
• communication with authorised family, carers or representatives

A brief appointment confirmation or similarly trivial administrative message is generally not separately billed. Substantive clinical communication, advice, review or coordination may be billed where permitted and agreed.

Multiple short, related communications may be grouped transparently where the billing system supports that approach. Entries must reflect the time actually spent and must not exaggerate time. PBSG will respect the participant’s approved contacts and information-sharing choices in accordance with the Privacy Policy.

8. Session notes and records

Practitioners must create adequate clinical records. Participant-specific documentation directly associated with delivering a support may be billed where the applicable rules and agreement permit it.

Clinical documentation is different from general business administration. PBSG bills 15 minutes per session for writing clinical notes where that work is billable under the applicable NDIS rules and Service Agreement.

9. Training and resources

Agreed, participant-specific training and implementation support may involve:

• needs analysis
• participant-specific training design
• preparing or adapting participant-specific materials
• delivery, attendance and permitted travel
• participant-specific post-training questions or review
• competency or implementation follow-up within PBSG’s scope

Reusable general resources and general staff training costs are not automatically charged in full to one participant. PBSG may charge only participant-specific preparation or a fair allocation where that allocation is permitted and agreed.

10. Travel

Where billable under the NDIS and the Service Agreement, travel charges may include practitioner travel time and non-labour costs such as kilometres, road tolls, parking or public transport. The maximum applicable NDIS rate in force when the travel is delivered always applies, subject to the applicable rules and caps.

• PBSG plans routes reasonably and identifies travel on the invoice.
• Travel shared between participants is apportioned fairly where the rules permit shared charging.
• PBSG does not duplicate a travel charge or charge the whole shared journey to each participant.
• Remote or very remote loadings apply only where the current rules, location and agreed support permit them.
• PBSG may discuss telehealth instead of travel where it is clinically appropriate and the participant agrees.
• If a cancellation occurs after travel has started, only travel or other work permitted by the current rules and agreement may be charged, with regard to fairness and the circumstances.

At this policy’s effective date, PBSG bills kilometres at $1.00 per KM and travel time up to 1 hour total (30 minutes each way), where billable under the applicable rules and Service Agreement. If the applicable NDIS maximum changes, the pre-agreed maximum-rate formula automatically replaces the published rate prospectively from the change’s effective date.

11. Cancellations, late cancellations and no-shows

PBSG’s current operational notice period is 48 hours. If PBSG receives less than 48 hours’ notice, or the participant does not attend at the scheduled time, PBSG reserves the right to claim the full cost of the scheduled time where the current NDIA rules, other applicable funding conditions and the signed Service Agreement allow it.

To cancel, contact the practitioner through the agreed contact channel or email hello@pbsg.com.au or call 0468 167 025. Notice is considered received when PBSG receives it. The 48-hour period is counted back from the scheduled start time. If you are unsure whether the message arrived, ask PBSG to confirm receipt.

• A cancellation received less than 48 hours before the scheduled start, or a no-show, may be charged at the full cost of the scheduled time where the applicable rules and Service Agreement permit.
• PBSG will not bill the participant and another person for the same cancelled appointment time.
• No cancellation charge is made if the applicable rule requirements are not satisfied.
• Reasonable participant-specific work already completed may still be billed even if a later meeting or session is cancelled.
• PBSG may review, reschedule, pause or end the service arrangement in accordance with the Service Agreement and applicable law.
• PBSG may offer telehealth or rescheduling where clinically appropriate.

12. Funding arrangements

How an invoice or claim is handled depends on the agreed funding type. A funding pathway does not guarantee that a claim will be accepted.

Tell PBSG promptly about plan dates, funding changes, plan-manager changes, budget limits and service bookings where relevant.

13. Funding availability, rejected claims and exhausted budgets

• PBSG may check information available to it but cannot guarantee a participant’s remaining budget or claim eligibility. An NDIS plan is not an unlimited guarantee of payment.
• If a claim is rejected, PBSG will investigate the reason and correct its own error without charging for that correction.
• PBSG will not automatically transfer an invalid or provider-caused rejected claim to the participant.
• If an authorised support was properly delivered but the nominated funding source lawfully does not pay, PBSG will discuss the issue and the signed Service Agreement will govern responsibility.
• When PBSG becomes aware that an agreed budget or cap is close to exhaustion, it should warn the participant or authorised representative.
• PBSG will not knowingly continue substantial non-urgent work beyond an agreed cap without further approval.
• PBSG may pause non-urgent services after reasonable notice where funding is not confirmed or invoices remain unpaid, while considering safety, continuity and a reasonable transition.

14. Invoices and payment

PBSG’s standard payment term is 7 days from the invoice issue date, unless the signed Service Agreement or pricing schedule records another agreed term.

An invoice may include:

• the participant’s name and any identifier required for payment
• the service date, support item or service description
• the quantity or duration and applicable rate
• a clear description of direct support, non-face-to-face support or travel
• GST treatment where relevant
• provider details and payment instructions
• the invoice date and due date

Many NDIS supports are GST-free when the legal requirements are satisfied, but GST may apply to other services. The invoice will state the GST treatment that applies. PBSG does not publish bank account details on this policy page.

15. Overdue accounts

PBSG uses a proportionate escalation process:

1. send a reminder or ask for clarification about the responsible payer;
2. give an opportunity to raise a dispute or provide missing claim information;
3. reasonably discuss a payment arrangement where appropriate;
4. consider pausing non-urgent services after notice, with regard to safety and continuity; and
5. after notice, pursue debt recovery or other recovery steps permitted by the Service Agreement and applicable law.

This policy does not impose interest, late fees, collection costs, a deposit or automatic direct-debit authority.

16. Billing questions, errors and disputes

1. Contact hello@pbsg.com.au with the invoice number and the item you question.
2. PBSG will acknowledge and review the matter. You can ask for an itemised explanation.
3. A genuinely disputed amount will not be treated as finally determined while the review is underway. Any undisputed amount remains payable.
4. PBSG will correct a provider error promptly and will not charge for correcting its own error.
5. If the issue is not resolved, you may make a complaint to Director Matthew Bowdler at matt@pbsg.com.au or use PBSG’s contact pathway.

Where relevant, you can also report an issue or make a complaint to the NDIS Quality and Safeguards Commission. Raising a concern will not adversely affect your right to respectful services.

17. Illustrative billing examples

These examples explain how the policy may apply. They do not set a rate, billing increment, guaranteed outcome or participant-specific term.

18. Frequently asked questions

19. Policy changes

PBSG may update this policy by publishing the new version and effective date on this website. Where the Service Agreement incorporates PBSG’s current policies, the published update applies prospectively as part of the service terms without a separately signed variation, subject to applicable law.

• Published policy changes apply prospectively and do not alter charges already incurred.
• Material changes affecting participant rights, charges or service access will be communicated through reasonable channels before taking effect.
• Changes to NDIS maximum rates apply automatically and prospectively under the pre-agreed Service Agreement pricing formula.
• Nothing in this policy limits rights that cannot lawfully be excluded.