12 Billing Leaks Your Practice Can Plug This Month.
Most allied health practices lose money in small, quiet ways: a late cancellation nobody charged, a rejected claim nobody resubmitted, a report nobody billed. A structured 12-point audit of your allied health billing and admin can find these leaks by checking the gaps busy weeks hide.
The timing matters. For 2026 to 2027, the NDIA held price limits for occupational therapy and speech pathology at $193.99 an hour, and physiotherapy at $183.99. When your rate stays the same, the revenue you have already earned matters more.
The audit takes one afternoon. You score each point from 0 to 2, estimate what each gap costs a month, then fix the three biggest first. Each fix gets a named owner and a review date.
The 12 points fall into four groups:
Charge for the time you hold. Cancellations, same-day invoicing and gap fees (points 1 to 3).
Get claims paid the first time. Medicare, health fund and NDIS claiming, plus software fee settings (points 4 to 7).
Collect what you have earned. Aged debtors and billable non-face-to-face work (points 8 and 9).
Cut admin drag and fixed costs. Admin time, fee schedules and subscriptions (points 10 to 12).
Free Resource: Practice Operations Audit
A practical audit tool that helps practices identify revenue leaks, improve billing and administrative processes, strengthen cash flow, and prioritise operational improvements.
Digging Deeper
Held NDIS price limits make every billing leak cost more
The NDIS kept hourly price limits steady for the therapies most clinics deliver to NDIS participants. The NDIS Pricing Schedule 2026-27, effective 24 September 2026, sets these limits for standard therapy items.
| Discipline | Hourly limit | Change |
|---|---|---|
| Occupational therapy | $193.99 | Held |
| Speech pathology | $193.99 | Held |
| Physiotherapy | $183.99 | Held |
| Dietetics | $178.99 | Down from $193.99 |
| Exercise physiology | $161.99 | Down from $166.99 |
| Psychology | $252.99 | Increased |
Splose’s summary of the pricing review notes that no adjustments were recommended for occupational therapy or speech pathology. The schedule also lists separate line items for cancellations, non-face-to-face work, NDIA-requested reports, telehealth, and provider travel.
These limits are maximums for NDIA-managed and plan-managed participants. Your private fees and Medicare work sit outside them, but the same allied health billing leaks apply across every funding source.
Run the audit in one afternoon with a 0 to 2 score
Block three to four hours with the practice owner and your senior admin. Pull the reports before you start, so the afternoon goes on scoring rather than searching.
Pull the reports. Cancellations and no-shows, unbilled appointments, Medicare and NDIS rejections, aged debtors, your fee schedule and your subscription list.
Score each point. Use 0 for not in place, 1 for partly in place, and 2 for in place and checked.
Estimate the monthly cost. For each score below 2, multiply how often the leak happens by its typical value.
Pick the top three. Rank by monthly cost, then by how quickly you can fix each one.
Assign owners and dates. Name one person per fix and set a review date 90 days out.
| Score | Meaning | Example for point 2 |
|---|---|---|
| 0 | Not in place | Invoices raised in batches at month end |
| 1 | Partly in place | Most invoiced on the day, with no daily check |
| 2 | In place and checked | Unbilled report cleared before close each day |
The maximum score is 24. Treat the total as a health check, and use the cost estimate to decide what to fix first.
Points 1 to 3: Charge for the time you hold
These three points protect appointments already in the diary. A missed cancellation fee or an uninvoiced session can cost a full appointment fee.
1. Late cancellations and no-shows. Write the policy down, apply it consistently for every clinician, and track each instance. A policy some clinicians quietly waive still leaks.
2. Every appointment invoiced on the day. Run an unbilled appointments report before closing each day. Anything left overnight is easy to forget and harder to collect.
3. Private gap fees collected at the time of service. Take payment at the desk, straight after any on-the-spot health fund claim. Chasing a small gap by email can cost more admin time than it recovers.
Missed appointments happen even in well-run services. A 2025 study of two physiotherapy clinics at an Australian metropolitan hospital found non-attendance rates of 8% and 10%. The authors placed these at the lower end of earlier research.
For NDIS therapy, a short-notice cancellation generally means the participant gave less than two clear business days’ notice. Under the NDIA’s Pricing Arrangements and Price Limits, you can claim up to the full agreed fee where the support item allows it.
Conditions apply. You must not have found other billable work for that clinician. You must also have paid them for the lost time, unless you are a sole trader or partnership.
Set out your cancellation terms in each participant’s service agreement. There is no hard limit on short-notice cancellations, but the NDIA monitors unusual patterns, so track repeat cases.
For gap fees, HICAPS terminals let a clinic claim a client’s health fund benefit straight after the consult. The client then pays only the gap at the desk.
Tell clients your fee and likely out-of-pocket cost before the first appointment. The Commonwealth Ombudsman calls this informed financial consent: knowing how much treatment will cost. Note in the client record that you gave this information.
Points 4 to 7: Get claims paid the first time
A rejected claim is revenue you have earned but not received. These four points stop rejections at the source and catch the ones that slip through.
4. Rejected Medicare claims reviewed and resubmitted each week. Services Australia gives a reason code for each rejected claim. Once you know the reason, you can adjust and resubmit.
5. Provider numbers and item codes are correct. Check every clinician’s numbers against each site they work from, for Medicare and for each health fund.
6. Software fee settings match the fee policy. Check bulk-billing flags, concession rates and default items for each clinician and appointment type.
7. NDIS claims checked, lodged and followed up. Check plan funding before the service, lodge claims promptly and follow up every rejection.
Services Australia lists common rejection causes, including an incorrect item, a patient reaching the maximum allowable benefits, and eligibility problems. Its reason code list also covers referral issues, such as an expired referral or a service outside the referral period.
Chronic condition referrals need their own checks. Under a GP chronic condition management plan, eligible patients can use five Medicare allied health services per calendar year. You must send the referring GP a written report after the first and last service.
Keep a copy of each Medicare referral for two years from the first service under it. That record matters if a claim is ever questioned.
Provider numbers are location-specific. Medicare requires a provider number for each practice location, and each claim must carry the number for the location where you gave the service.
Health funds have their own steps. For example, Medibank asks providers to register each additional practice location, either through Medicare or directly with the fund. Add a check to your new-site and new-clinician checklists.
Software settings deserve a close look because a wrong default repeats on every appointment it touches. One misapplied concession flag can under-bill a clinician’s whole caseload until someone notices.
For the NDIS, claims must align with the approved funding in the participant’s plan, and the NDIA rejects non-compliant claims. You need to submit payment requests within two years of delivering a support.
For NDIA-managed funding, the window is 90 days from the end of a service booking. Claims lodged more than six months after the service may be held for review, so lodge weekly.
Checking funding before the service matters most. If a participant’s budget has run out, your clinician has still done the work.
Points 8 and 9: Collect what you have already earned
8. Aged debtors reviewed weekly. Sort unpaid invoices by age and follow a set sequence: reminder, phone call, then escalation at fixed points. One person runs it.
9. Non-face-to-face time billed where funding rules allow. Report writing and other work outside the session can be billable under some funding types, including the NDIS. If nobody records it, it is lost.
Under the NDIS, non-face-to-face time is claimable only where the support item allows it and the participant agreed in advance. The service agreement is the usual place to record that agreement.
The activities must be part of delivering that participant’s support, and fees must link to completed work. Staff training, supervision and general administration are not billable this way.
NDIA-requested reports have their own line item, but only when the NDIA has asked for the report. The participant must also agree in advance.
Provider travel for therapy is claimable at half the hourly price limit, when the participant has agreed. The cap is 30 minutes of travel per participant in cities and large regional centres, and 60 minutes in smaller regional towns.
These areas follow the Modified Monash Model (MMM), a remoteness scale. The 30-minute cap covers MMM 1 to 3, and the 60-minute cap covers MMM 4 to 5. Ask clinicians to record travel time with each home or school visit.
Points 10 to 12: Cut admin drag and fixed costs
10. Admin time per clinician measured. Ask each clinician to log admin time for two weeks. Move work admin staff can do, such as bookings, reminders and claim lodgement, to them.
11. Fee schedule reviewed every year and after any price limit change. Review private fees once a year, and NDIS fees whenever the price limits change.
12. Software licences and subscriptions reviewed. List every subscription, who uses it and what it costs. Cancel licences for departed staff and tools nobody opens.
Clinician time is the main thing your practice sells. An hour of admin a clinician does that the front desk could do is an hour nobody can book.
The 2026 to 2027 changes show why point 11 matters. A clinic still using last year’s NDIS dietetics rate of $193.99 would now sit above the new $178.99 limit.
The NDIA has also said it will update the 2026-27 Pricing Schedule later this year. Put a check of the NDIS pricing page in the practice calendar each quarter.
Subscriptions creep as a clinic grows. A yearly review against your staff list can find licences for people who left months ago.
Estimate monthly leakage before you fix anything
A rough dollar figure turns a list of gaps into a ranked plan. For each point scored 0 or 1, estimate how often the leak happens in a month and what each instance is worth.
| Leak | Monthly count | Cost |
|---|---|---|
| Late cancellations not charged | 10 at $190 | $1,900 |
| Rejected claims not resubmitted | 8 at $90 | $720 |
| Report time not billed | 6 hours at $190 | $1,140 |
| Unused software licences | 3 at $60 | $180 |
Illustrative only. These figures are invented to show the method. They are not a benchmark, a forecast or a promise of what your practice will recover.
Use your own reports for the counts and your own fees for the values. Where you cannot count a leak, sample one typical week and multiply by four.
Fix the top three first and give each an owner
Twelve fixes at once tends to mean none get finished. Pick the three leaks with the highest monthly cost, and start there.
| Owner | Points they usually own |
|---|---|
| Practice manager | 1, 8, 10 and 11 |
| Senior receptionist | 2, 3 and 6 |
| Claims or billing officer | 4, 5 and 7 |
| Clinicians | 9, by recording billable time |
| Practice owner | 11 and 12, approving changes |
Give each fix a named owner, a due date and one simple measure, such as unbilled appointments at close each day. Re-score all 12 points after 90 days to check the fixes have held.
Common questions from practice managers
How long does the 12-point audit take?
Most of the work is pulling reports, so prepare them first. With reports ready, a practice manager and senior admin can score all 12 points in one afternoon.
Can we charge NDIS participants for every late cancellation?
Only where the support item allows it, notice was less than two clear business days, and your service agreement sets out the terms. You can also choose to waive the fee.
Does each clinician need a provider number at each site?
For Medicare, yes: a health professional must have a provider number for each practice location. Health funds also expect each location to be registered, so check each fund’s process.
Can we bill NDIS participants for report writing?
You can claim non-face-to-face time where the support item allows it and the participant agreed in advance. NDIA-requested reports have a separate line item when the NDIA has asked for the report.
How often should we repeat the audit?
Re-score the 12 points every 90 days while you are fixing the top three. After that, a full audit each year, plus after any NDIS price change, keeps the gaps closed.
How can SBAAS help
Small billing leaks are easy to miss when the diary is full, and the front desk is busy. SBAAS runs operations gap analysis and billing compliance reviews for allied health practices. We check your processes, software settings and claiming against the funding rules, then rank the fixes by what they cost you. As a Xero Silver Partner, we also understand how billing data flows into your accounts.
We start with a scoped proposal, so you can see the work and the cost before you commit. Book a short call to see whether a review would suit your practice: https://sbaas.com.au/about-us/
Free Resource: Practice Operations Audit
A practical audit tool that helps practices identify revenue leaks, improve billing and administrative processes, strengthen cash flow, and prioritise operational improvements.
General information
This article is general information only. It is not legal, financial or tax advice. Check current requirements with the relevant regulator and obtain advice for your specific circumstances before relying on this information.
Sources
Commonwealth Ombudsman. (n.d.). Informed financial consent. https://www.ombudsman.gov.au/publications-and-news-pages/publication-pages/brochures-and-factsheets/factsheets/private-health-insurance/informed-financial-consent
Department of Health. (2018, July 1). Changes to record-keeping requirements under the Health Insurance Act from 1 July 2018. MBS Online. https://mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/news-2018-07-01-Changes-to-Recordkeeping-+under-HIA
Lynch, S. (2026, June 23). The 2026-27 annual pricing review: What it means for allied health providers. Splose. https://splose.com/resources/the-handover/the-2026-27-annual-pricing-review-what-it-means-for-allied-health-providers
Medibank. (n.d.). Additional practice locations. https://www.medibank.com.au/providers/add-location/
Mohammed Selim, S., Naicker, S., Kularatna, S., Carter, H. E., Borg, S., Armstrong, C., Walkenhorst, M., Kunst, B., & McPhail, S. M. (2025). Cost of physiotherapy non-attendance at a metropolitan hospital in Australia: A time-driven activity-based costing study. BMJ Open, 15(5), e083420. https://pmc.ncbi.nlm.nih.gov/articles/PMC12104927
National Disability Insurance Agency. (2025, October 14). NDIS Pricing Arrangements and Price Limits 2025-26 (Version 1.1). NDIS. https://ndis.gov.au/media/8096/download?attachment
National Disability Insurance Agency. (2026, September 24). National Disability Insurance Scheme Pricing Schedule 2026-27. NDIS. https://ndis.gov.au/media/8841/download?attachment
National Disability Insurance Agency. (2026, September 24). New price limits set for NDIS supports. NDIS. https://ndis.gov.au/news/11701-new-price-limits-set-ndis-supports
National Disability Insurance Agency. (2026, September 24). Pricing arrangements and price limits. NDIS. https://ndis.gov.au/providers/pricing-and-payments/pricing/pricing-arrangements-and-price-limits
National Disability Insurance Agency. (2026, July 14). Getting paid as a provider. NDIS. https://ndis.gov.au/providers/pricing-and-payments/payments/guide-getting-paid
Psychotherapy and Counselling Federation of Australia. (2026, August). Accept instant private health insurance claims with HICAPS. https://www.pacfa.org.au/portal/News-and-Advocacy/news/2026/August/instant-private-health.aspx
Services Australia. (2024, July 11). Managing Medicare rejected claims. https://www.servicesaustralia.gov.au/managing-medicare-rejected-claims
Services Australia. (2025, November 1). Allied health and other primary health care referrals for GP chronic condition management plans. https://www.servicesaustralia.gov.au/allied-health-referrals-for-chronic-disease-health-care-plans
Services Australia. (n.d.). Education guide: Medicare reason codes and reducing claim rejections. https://www.servicesaustralia.gov.au/education-guide-medicare-reason-codes-and-reducing-claim-rejections
Services Australia. (n.d.). Provider numbers for health professionals in Medicare and the Provider Directory System (PDS) (012-42010010). Operational Blueprint. https://operational.servicesaustralia.gov.au/public/Pages
Eric Allgood is the Managing Director of SBAAS and brings over two decades of experience in corporate guidance, with a focus on governance and risk, crisis management, industrial relations, and sustainability.
He founded SBAAS in 2019 to extend his corporate strategies to small businesses, quickly becoming a vital support. His background in IR, governance and risk management, combined with his crisis management skills, has enabled businesses to navigate challenges effectively.
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