Billing WorkSafeBC for

Transcription

1 Please note that the physiotherapy clinic must have a valid contract in order to provide services under Standard or Post-Surgical Eligibility and Assessment Blocks (Standard and Post-Surgical ) Does the worker have a claim that is either pending or accepted? To find out, check on the status of their claim online or call Is the date of the worker's initial assessment within 60 days of the date of injury or date of accepted surgery? You must contact the worker s claim owner for approval prior to providing any treatment. Has the worker already undergone an Assessment Block elsewhere, or attended a rehabilitation program prior to coming to your clinic? You will need to complete a Secondary Assessment and submit the Secondary Assessment Report. This is billed as fee code Secondary Assessment (this includes 1 clinic visit and the Secondary Assessment report) You may proceed with the Assessment Block. Please ensure that you adhere to the following guidelines: Reporting The Initial Report cannot be submitted until the physiotherapist has successfully contacted the worker's employer, OR until the seventh day of the Assessment Block. Date of Service The Date of Service (DOS) written on the Initial Report is the date of the client s very first visit. Billing The Assessment Block is billed as the date of the client s very first visit (i.e. the Date of Service (DOS) written on the Initial Report).

2 Block (Standard and Post-Surgical ) Is the worker s claim accepted? To find out, check on the status of their claim online or call is only payable on accepted claims. Please continue to await a claim decision. Have you completed a recent Assessment Block or Secondary Assessment for this worker? Please read the section on Eligibility and Assessment Blocks. Has this worker already received claim-related physiotherapy treatment or attended a rehabilitation program prior to coming to your clinic? You may proceed with a Block. Please ensure that you adhere to the following guidelines: Confirm approval with the claim owner and then proceed with an Extension Block. If the worker changed providers mid-treatment block, then please call Health Care Services at for directions on how to proceed. General Standard Blocks consist of 6 weeks of treatment. Post-Surgical Blocks consist of 8 weeks of treatment. You must see the worker at least twice per week. Timeframes The Block cannot begin until the Initial Report has been submitted. Any visits which occur prior to the Initial Report s submission are considered part of the Assessment Block. Billing The Block is billed at the end of the block, using the same Date of Service as the one written on the report that is submitted at the end of the Block (i.e. the first Extension Report, or the Discharge Report).

3 First Extension Block (Standard and Post-Surgical ) Did you submit the Extension Request Report at least 1 week prior to the end of the Block? Proceed with treatment into the first Standard or Post Surgical Extension Block unless you hear otherwise from the claim owner. You must await approval of the Extension Block before proceeding with treatment. Will the worker require further treatment at the end of the 4 week Extension Block? Submit a Discharge Report. The Date of Service on the Discharge Report should be the last visit the worker attended for treatment. Second Extension Block (Standard or Subsequent Post-Surgical ) Extension Request Report must be submitted at least 1 week prior to the end of the Extension Block. Did you receive approval from the claim owner for the Extension Block? You may proceed with an Extension Block; either a Standard or Subsequent Post-Surgical Extension Block. You must await approval of the Extension Block before proceeding with treatment.

4 Invoicing Extension Blocks vs. Daily Rates (Standard or Post-Surgical ) Did the worker attend 4 or more visits in the Extension Block? Invoice for the appropriate Extension Block Standard Extension Block Fee Code 19294* Post-Surgical Extension Block Fee Code 19300* Subsequent Post-Surgical Extension Block Fee Code 19309* Invoice Daily Rates for the visits provided (3 visits or less) Standard Daily Rate Fee Code Post-Surgical Daily Rate Fee Code *The Extension Block Fee Codes are inclusive of all treatment provided in the Extension Block, including the Extension Request Report initiating the Extension Block being invoiced. Do not invoice the Extension Request Report separately. When 3 or fewer visits are provided in the Extension Block (Standard/Post- Surgical/Subsequent Post- Surgical) and Daily Rates are invoiced instead, the approved Extension Request Report that initiated the Extension Block needs to be invoiced separately using: Standard Extension Request Report Fee Code Post-Surgical Extension Request Report Fee Code This is the only time the Extension Request Report should be invoiced separately If an Extension Request Report is submitted and subsequently denied, that report is not payable. The treatment approved from the previous report is still payable, and the Discharge Report should still be submitted and invoiced at the end of the approved or Extension Block.

5 Summary of Block Billing Standard Post-Surgical Service: Standard Assessment Block Fee Code: Duration: 1-7 days Report: Standard Initial Report Service: Post-Surgical Assessment Block Fee Code: Duration: 1-7 days Report: Post-Surgical Initial Report Service: Standard Block Fee Code: Duration: Up to 6 weeks (min. 2 visits/week) Report: Extension Request Report or Discharge Report Service: Post-Surgical Block Fee Code: Duration: Up to 8 weeks (min. 2 visits/week) Report: Extension Request Report or Discharge Report Service: Standard Extension Block(s) Fee Code: Duration: Up to 4 weeks (min. 2 visits/week) Report: Extension Request Report or Discharge Report Service: Post-Surgical Extension Block* Fee Code: 19300* Duration: Up to 4 weeks (min. 2 visits/week) Report: Extension Request Report or Discharge Report *Only to be billed for the first PS Extension Block Service: Post-Surgical Subsequent Extension Block(s)* Fee Code: 19309* Duration: Up to 4 weeks (min. 2 visits/week) Report: Extension Request Report or Discharge Report *To be billed for all Subsequent Post-Surgical Extension Blocks after the first Post-Surgical Extension Block blocks and Extension Blocks must be billed using the Date of Service written on whichever report is submitted at the end of the block (either an Extension Request Report, or a Discharge Report). The Date of Service must be completed on the report, and must match the Date of Service billed.

6 Frequently Asked Questions Q: What if the worker attends less than 4 visits during their or Extension Block? (te: Post-Surgical block invoicing is triggered at 6 visits) A: If the worker attends 3 or less visits during a Standard Block, or a Standard/Post-Surgical Extension Block, those visits should be billed as Daily Rates* not a whole block. If a worker attends 5 visits or less during a Post-Surgical Block, those visits should be billed as Daily Rates* *Keep in mind that Standard and Post-Surgical each have a separate fee code for Daily Rates. Q: How do we calculate the start and end dates of blocks? A: Start and end dates are visit-based. For example, the Block begins as of the client s next visit date after the Initial Report has been faxed to WorkSafeBC. The client s Extension Block begins as of the client s next visit after the end date of the previous block. Q: What should we do if the worker misses treatment time (e.g. illness, vacation, shift work, etc.)? A: If the worker will absent for 7 calendar days or more* they should be placed on a Program Interrupt. Ensure that you contact the client s claim owner to inform them of the interrupt and the new estimated block end date. Time missed should be added onto the end of their current block, upon their return to the clinic. *If the worker will be absent for more than 3 weeks, you should contact the claim owner to discuss if an interrupt greater than 3 weeks would be approved, or if the worker should be discharged. Q: How should we bill for a worker who has switched to our clinic after attending treatment at another physiotherapy clinic, or a rehabilitation program (like OR1/OR2, Hand Therapy, etc.)? A: You should begin with a Secondary Assessment and submit the Secondary Assessment Report. Going forward, it depends on how much treatment the worker received at the previous clinic. Please call Health Care Services at (press 2 to speak to reception) for directions on how to proceed if the worker changed mid- Block. If the worker changed during Extension Blocks, then billing should continue in Extension Blocks provided the treatment has been approved by the claim owner.

7 Eligibility for Secondary Assessments Secondary Assessment must be completed, instead of the Assessment Block, when: The worker has received physiotherapy treatment at another clinic, prior to coming to your clinic for physiotherapy treatment The worker has participated in a rehabilitation program (e.g. Occupational Rehabilitation, Hand therapy, etc.) prior to coming to your clinic for physiotherapy treatment; or There is a gap in physiotherapy treatment Eligibility for Post-Surgical In order for a worker to be eligible for Post-Surgical, the following conditions must be met: The worker must have undergone surgery (injections and nerve-root blocks are not considered surgeries) The surgery must be claim-related and approved by their claim owner The worker must be commencing, or restarting, physiotherapy within 60 days from the date of the approved, claim-related surgery* *If it has been over 60 days from the client s date of surgery and the physiotherapist feels that Post-Surgical is still warranted, they must call Health Care Services at to provide rationale, and obtain approval, from the Quality Assurance Supervisor. Eligibility for Complex Exception Fees Under extenuating circumstances, the physiotherapist may wish to apply for the Complex Exception Fee (CEF). This is an uplift fee that may be billed in addition to an approved Standard Extension Block, or an approved Subsequent Post-Surgical Extension Block. In order to obtain approval to bill this fee, the physiotherapist must submit the Complex Exception Fee Request Form, documenting medical evidence/clinical rationale and the physiotherapy treatment plan. Please note: Approval for the CEF must be obtained from Health Care Services, not the worker s claim owner This is an uplift fee only, and does not change the length of time in an Extension Block The physiotherapist must obtain CEF approval for each Extension Block that they feel is appropriate. Each CEF application form submitted is only valid for the Extension Block specified on the request form The CEF Request Form is available online

8 Billing for Telephone Consultations The telephone consultation fee code (19204) should only be billed when the physiotherapist has communicated meaningful details on a worker s treatment, return-to-work plans, or other related issues with the worker s health care provider, a claim owner or medical advisor, or the client s employer (outside of the Assessment Block). Please be sure to bill for the date of the phone call, and keep a record of this communication. Please keep in mind that you should not bill us for routine, administrative, and/or quality assurance issues. Billing for Clinical Records When you are requested to provide a copy of a worker s clinical chart notes, please ensure that the chart notes are: Clearly legible Provided within two business days of the date of the request Billed for the date of the request, not the date the chart notes were sent to WorkSafeBC Billing for Supplies/Equipment All durable medical supplies, durable equipment, braces and splints must be approved by the client s claim owner prior to billing. Please note you cannot charge WorkSafeBC, nor the worker, for basic clinic supplies or non-durable medical supplies such as: thera-band, tape, gel, electrotherapy pads, ice packs, and hot packs. The appropriate fee codes for supplies/equipment can be obtained from Payment Services upon approval of the item(s).

9 Transferring Coverage from Private If you are made aware that a worker has a WorkSafeBC claim within 90 days from when they began treatment with you, you must accurately backdate reports and billings to the start date of their treatment at your clinic. For instructions/assistance on accurately backdating reports and billings, please contact Health Care Services at If you are made aware that a worker has a WorkSafeBC claim over 90 days after they began treatment with you, the worker can submit their receipts to WorkSafeBC for direct reimbursement. If treatment is ongoing when you find out, please begin billing and reporting to WorkSafeBC as of the client s next visit, once you are made aware of their WorkSafeBC claim.* *Be sure to check with the claim owner, first, that ongoing physiotherapy treatment is approved, and contact Health Care Services at for assistance with how to bill. Invoicing Guidelines Please be sure to adhere to the following WorkSafeBC policies regarding invoice submission: All services must be billed to WorkSafeBC within 90 days of the date of service Invoice corrections must be made either within 180 days of the date of service, or within 90 days of the first rejection (provided the service was originally billed within 90 days of the date of service) Services should be billed electronically whenever possible If the worker does not have a BC Personal Health Number then please refer to the Submitting Invoices section of the Reference Manual for how to invoice If, in extenuating Circumstances, you are required to fax or mail you invoices, please use the Invoice for Services template, Form 267, available here on our website. Please ensure that all mandatory fields are completed, and that you are invoicing correctly. For assistance with completing this form, please contact Health Care Services at The Clinic or individual physiotherapist must have an active contract in order to provide services and bill for them.

10 Assessing Invoice Rejections Invoice rejections indicate that an error was made in the way that the service was billed. Depending on the rejection code, you may be able to determine what the error is. If you are unable to determine the error in the billing based on the rejection code you receive, please follow the steps below: 1. Confirm the basic information for the service billed: Worker s personal, claim, and injury information/codes Clinic s information 2. Confirm approval of the services billed (by referring to chart/file notes): Is the claim accepted? Did the claim owner provide pre-approval of this service? If extenuating circumstances, did Health Care Services provide preapproval of the billings? 3. Confirm the billing information for the service billed: Is the fee code correct (correct block, Standard vs. Post Surgical )? Is the Date of Service correct? Check the corresponding report for the date of service to be sure. (You should be billing for the date of service on the report, not the date faxed.) Was the corresponding report successfully faxed to WorkSafeBC? 4. Confirm that the payee number is correct: Is the MSP payee number that is being used to invoice the same payee number on Schedule C of your contract. If your contract has recently started, then ensure the Date of Service billed is after the effective start date of your contract. 5. Still encountering a rejection code? Call Payment Services at for assistance.

11 Please note that the Vestibular, Neurological, and Home do not require a contract in order to provide services; however, you must abide by the fee schedule rules and rates. Hydrotherapy When clinically appropriate, hydrotherapy may be provided to the worker in conjunction with Standard or Post-Surgical. When providing hydrotherapy in conjunction with Standard or Post-Surgical, it is important to keep in mind that: Hydrotherapy visits are billed separately and, therefore, do not count towards the contract minimum of 2 visits per week for Standard or Post-Surgical or Extension Blocks If the physiotherapist is delegating the supervision of hydrotherapy visits to a different practitioner, they must bill using the Delegated Hydrotherapy fee code. For more information on billing for Hydrotherapy, click here. Vestibular Vestibular physiotherapy may be provided when a worker presents with: Mild/moderate traumatic brain injury (with associated vestibular dysfunction); and/or Vestibular disorders Concussion The physiotherapist must receive approval from the claim owner prior to a vestibular assessment or vestibular treatment. For more information on billing for Vestibular, click here. Neurological Neurological may be provided when an injured worker presents with: Moderate or severe traumatic brain injury (with associated physical dysfunction) Cranial nerve disorders Cauda equine lesions with neurological signs Spinal cord injury; or Acute traumatic spinal injury (with upper motor neuron lesion signs) The physiotherapist must receive approval from the claim owner prior to a Neurological assessment or Neurological treatment. Please note that Neurological and physiotherapy clinic visits (Standard and Post-Surgical blocks) cannot occur concurrently. For more information on billing for Neurological, click here. Home Home physiotherapy may be provided when a worker is unable to safely travel to a physiotherapy clinic, or when a claim owner approves treatment in the client s residence due to the nature and severity of their injury. Please note that Home and physiotherapy clinic visits (Standard and Post-Surgical blocks) cannot occur concurrently. For more information on billing for Home, click here.

12 Contact us Claims Call Centre Payment Services Call the Claims Call Centre for: Claim status Basic claim information (e.g. date of injury, injury codes) Claim owner contact information Toll free: Call Payment Services for: Assistance with billing rejections Assistance understanding invoice correction letters Health Care Services Claim Owner Call Health Care Services for: Information on how to bill, prior to sending an invoice Information on the Memorandum of Agreement Clinical questions Quality Assurance issues Contact claim owner for: approval Discussing client s condition and progress Discussing return-to-work plans and recommendations tification of program interrupt (<3 weeks), or approval for an extended program interrupt (>3 weeks) Additional Resources WorkSafeBC physiotherapists provider information page Memorandum of Agreement Services Reference Manual Agreement fee schedule Check a claim s status online Watch the invoicing webinar