New rates for CoTR providers confirmed
Providers treating patients under the Cost of Treatment Regulations (CoTR) will receive increased ACC contributions from 1 December following approval by Government.
The increased rates will mean some New Zealanders will get cheaper visits to their doctor, and more children will be entitled to the zero-fees scheme.
What's changing?
- There will be a general inflation increase of 1.56% applied to all CoTR providers
- We're extending the contribution ACC currently provides to General Practice for visits by children under 13 years, to children under 14 years
- We're making a higher contribution towards Community Services Card (CSC) holders and their dependants (aged 14 – 17 years old).
GPs will get a higher rate for patients with Community Service Cards, with the expectation the patient will pay no more than $18.50 for a visit.
Their dependants (aged 14 -17 years) will be charged no more than $12.50. Additional contributions will also mean the current zero-fees scheme for under 13s will be extended to under 14s.
These new rates will also apply to practices working under contract – Rural General Practice and Urgent Care Clinics.
Invoicing ACC
Providers working under CoTR need to make sure they invoice ACC at the new rates from 1 December. You'll bill as you always do, however invoices during the changeover week will need to include both new and old codes/rates if you have consultations on either side of 1 December.
Who's affected?
The inflation increase applies to:
- counsellors
- dentists
- hyperbaric treatment providers
- radiologists
- medical practitioners
- nurses
- nurse practitioners
- specialists
- and specified treatment providers
- acupuncturists
- chiropractors
- occupational therapists
- osteopaths
- physiotherapists
- podiatrists
- speech therapists.
Primary care increases:
- general practice doctors
- nurses
- nurse practitioners.
New rates for GPs
We expect practices will be able to charge CSC holders an $18.50 co-payment ($12.50 for dependants of CSC holders aged 14 -17 years) and provide under 14-year-olds with zero fees.
It is up to individual practices to set their co-payment levels, however, the prices are set at a level to encourage practices to pass on the benefits to their patients.
Contribution rates for general practice visits for CSC holders (excl. GST)
| New contribution rate for CSC holders (with the 1.56% increase) | |
|---|---|
|
GP consultation |
$53.33 |
|
GP and nurse |
$56.32 |
|
Nurse practitioner |
$49.06 |
|
Nurse consultation |
$27.61 |
Contribution rates for general practice visits for dependants (aged 14 -17 years-old) of CSC holders (excl. GST)
| New contribution rate for dependents of CSC holders (with the 1.56% increase) | |
|---|---|
|
GP consultation |
$58.54 |
|
GP and nurse |
$61.54 |
|
Nurse practitioner |
$53.86 |
|
Nurse consultation |
$32.83 |
GP visit contribution rates for under 14s (excl. GST)
| New contribution rate for children under 14 years old (with 1.56% increase) | |
|---|---|
|
GP consultation |
$56.94 |
|
GP and nurse |
$59.93 |
|
Nurse practitioner |
$52.37 |
|
Nurse consultation |
$31.93 |
The primary care changes are part of announcements made by the Government in Budget 2018 and apply to both health and injury-related visits. These initiatives are about helping more New Zealanders access their doctor or nurse by reducing barriers such as cost.
How to bill for services using the new rates
Providers using practice management systems
If you use a practice management system, your PMS vendor will advise you when the updates are available. This means you can bill for services at the new rates when you update your system.
It’s important that you do this before 1 December 2018, so that the new codes are available to you.
Providers billing manually or through ACC Online
If you don’t use a practice management system you can continue to invoice us for services as you do now, using the new codes and rates from 1 December.