Think of the Pricing Arrangements and Price Limits as your go-to guide for navigating the pricing rules and regulations set out by the NDIA. Every provider should aim to be in the know when it comes to pricing limits, line items, and any key changes that might be made. With updates being released each financial year (sometimes with minor updates throughout the year), there’s no better time than right now to understand the ins and outs of the Pricing Arrangements and how to use it effectively.
Using the Pricing Arrangements
The Pricing Arrangements and Price Limits has a list of over 2,500 items and services that can be funded by the NDIS. These items and services have a price limit (the maximum amount that can be charged) which is updated on a yearly basis.
With so many items and services listed in the Pricing Arrangements, sometimes it can be confusing trying to figure out which line item you should use when invoicing a client for your services. To make things easier, the Pricing Arrangements is broken down into categories. They are:
Core: help with everyday activities and community access.
Capital: fund Assistive Technology (AT) and/or Home Modifications.
Capacity Building: help to build skills and independence in daily life, and help you pursue your goals. Plan Management support is allocated under this support category under Improved Life Choices.
The Core, Capital and Capacity Building Supports have subcategories that can help you better understand where your supports and services are categorised. For each service listed in the Pricing Arrangements, there is a corresponding line item.
Top tip: remember to check for pricing limit differences corresponding to the time of day, night supports and public holidays.
Pricing Limits & Setting your Rate
Other than outlining the maximum amount that can be charged for supports and services, the Pricing Arrangements also shows:
Current and previous price limits for each support item
Claim types including travel and non-face-to-face supports
Price limits for different times of day
It’s important to use the Pricing Arrangements as a guide to help you make informed decisions when it comes to pricing your services.
Some questions you may want to consider after reviewing the Pricing Arrangements and before setting your price are:
What is your current experience level?
What price would be considered fair and provide value for money for each service provided?
Is there a pricing difference based on whether the support is in person or not in person?
Have you discussed pricing with the NDIS participant you are supporting?
Does there need to be an adjustment in the pricing that has been set?
For more information on setting your rate, check out our blog ‘Understanding & Making Pricing Decisions’.
Top tip: when setting your pricing, talk with your client to help them understand the decision making behind the price and involve them in the discussion.
What to do if your support fits into more than one line item
Sometimes you may find that your supports and services could fit into multiple line items. In this circumstance, pick the most relevant line item that aligns with your client’s Plan.
Exercise physiology appears in two Capacity Building budgets:
12 – Improved Health and Wellbeing
15 – Improved Daily Living
Using a support item code that is not included within the participant’s plan can cause slight delays if we need to confirm some details. For example, one of the budgets might be NDIA-managed, and should not be paid with plan managed funds.
How the Pricing Arrangements can help speed up your invoice processing
We receive lots of invoices every day, and each invoice is a little different. However, they should have some key elements* to help us to process them quickly. One of those key elements is including a line item. Although our team may be able to determine what line item your support corresponds to, by including it in the invoice it saves us time searching for the right line item, and our team can process invoices much faster.
*For a full checklist of everything you should include in your invoices, check out our downloadable Provider Invoicing Checklist.
If you have a participant who is plan managed with First2Care, you can register your details with our First2Care team for quick and easy payment processing. Read more about First2Care Plan Management here.