Attention: Physiotherapy Providers

Transcription

1 October 6, 2014 Attention: Physiotherapy Providers Subject/Outline: 1. Communication Requirements 2. Breaks in Service/Program Interrupts 3. Injured Workers who are not job attached 4. Subsequent Extension Blocks 5. Complex Exception Fee 6. Assessments >60 days post-injury 7. Report Templates 8. Supplies 9. Physiotherapy Hotline 1. Communication requirements Employer contact: Please be reminded that as per the contract you are required to make 2 attempts to contact the Worker s Employer. This includes allowing time between the phone calls in order for the Employer to return your call. Claim Owner contact: Please review the contract in terms of the requirements of when to and when not to contact a Claim Owner. For example, you should not be contacting a Claim Owner to determine the end-dates of blocks of treatment, unless there has been a significant break in service. Otherwise, merely count the number of weeks since the Worker started in either a Treatment Block or an Extension Block in order to obtain this date Page 1 of 5

2 2. Breaks in Service/Program Interrupts: Please note that if there is a planned, known absence of significant length (greater than 1 week) in a Worker s physiotherapy treatment, such as for a vacation, this time does NOT count towards the number of weeks of physiotherapy treatment that a Worker received. For example, if someone has 2 weeks of physiotherapy treatment in a Treatment Block and then goes on vacation for 2 weeks, when they return, they still have up to 4 weeks of physiotherapy treatment available to them in the Treatment Block. 3. Injured Workers who are not job attached: If an Injured Worker does not have a job to return to, please note the following: You are still required to attempt to contact the Worker s pre-injury Employer (where possible depending on the situation) in order to confirm the Worker s critical job demands. If you are not able to make contact with the Employer, obtain the critical job demands from the Worker and document these in your reports. Your treatment needs to be focussed on returning the Worker to their preinjury job demands, even if they don t have a job to return to. Your functional testing, treatment plan and reporting need to reflect this. 4. Subsequent Extension Blocks: As per the contract, Standard Treatment Services allows for one Extension Block and Post-Surgical Treatment Services allows for two Extension Blocks. As long as you have submitted Extension Request Reports for these extensions in a timely manner (at least 7 days prior to the Treatment Block s end date) and have attempted to contact the Claim Owner, you are free to assume that the first Extension Block is approved. If the Extension Block is subsequently denied, any treatment you have provided up until the time that the decision was communicated to you is payable by WorkSafeBC. Therefore, there is no need to pause treatment or continually attempt to contact the Claim Owner or their Service Coordinator if you have not received a response to the first Extension Request Report. There are situations where subsequent Extension Blocks may be clinically appropriate. If you believe your Injured Worker requires additional Extension Blocks beyond those provided in the respective Treatment Services, please contact the Claim Owner to discuss this recommendation. Page 2 of 5

3 Once it is agreed that an additional Extension Block may be warranted, submit an Extension Request Report to the Claim Owner. You MUST wait for approval prior to treating a Worker into a subsequent Extension Block. Once approved, you can continue to treat the Worker and invoice for the subsequent Extension Blocks. Subsequent extension blocks will not be paid unless there is approval from the Claim Owner. 5. Complex Exception Fee: Please note the following in regards to the Complex Exception Fee: The fee is only applicable for payment for Standard Treatment Services Extension Blocks. It is not paid in Post-Surgical Treatment Services or on the Treatment Block portion of Standard Treatment Services. If you are requesting an extension to physiotherapy treatment, please follow the guidelines provided in the contract. This includes submitting an Extension Request Report to the Claim Owner. The fax number is on the report. If you are requesting the payment of the Complex Exception Fee on the Extension Block portion of Standard Treatment Services, please follow the guidelines provided in the contract. This includes submitting a Request for Complex Exception Fee Form to Health Care Services. The fax number is on the form. There is no due date for the Complex Exception Fee Request, however please do not submit earlier then 1-2 weeks prior to the start of the Extension Block as the decision will be based on what is clinically relevant at the time and cannot be made far in advance. If you have been granted approval for payment of the Complex Exception Fee on an Extension Block in Standard Treatment Services and you have an additional Extension Block of treatment approved, and you believe this Worker meets the criteria for the Complex Exception Fee, you need to re-apply to Health Care Services using the Request for Complex Exception Fee Form. You cannot assume that if the Complex Exception Fee was approved once, it will be automatically approved a subsequent time. 6. Assessments > 60 days post-injury: If the Worker s first physiotherapy visit is greater than 60 days from the date of injury, you need to call the Claim Owner prior to proceeding with any assessment and/or treatment of the Worker, as physiotherapy treatment may not be authorized. Page 3 of 5

4 If the Worker s first physiotherapy visit is less than 60 days from the date of injury and they have a registered claim (either pending or accepted), you can proceed with the Assessment Block of treatment. 7. Report Templates: Please note that the report templates have been edited slightly, including changes to the Date of Service/Date of Report fields and the addition of a clinic fax number. In addition, we now have PDF versions of the report templates available. The new report templates can be found here: ( physiotherapists/default.asp). Please use the new report templates effective immediately. When submitting the Physiotherapy Extension Request/Requested Reports please ensure that you tick off the relevant box at the top of the form. Failing to do so may result in your invoice being returned unpaid. While it is preferred that you type out the reports, if you are filling the reports in by hand, please expand the boxes prior to printing the report to ensure you have enough space to fill out the report so that it is legible. 8. Supplies: The new Physiotherapy contract allows for the ability to invoice up to a maximum of $50.00 per claim for take-home supplies provided to the Worker. Please note that this does NOT mean that you should invoice $50.00 for every Worker regardless of whether you provided them with supplies or not. The supplies provided need to be relevant to their injury and treatment program. It also does NOT mean that when you invoice for the supplies you provided, that you have to invoice the full $ We expect to see invoices for the exact dollar amount of the supplies you provided. As this is a new service, we will be performing random audits to ensure the supplies provided and invoiced for meet the criteria as outlined in the contract. If you are unsure as to whether you should invoice for supplies or how to invoice correctly, please contact us for further direction. 9. Physiotherapy Hotline: As you are likely aware, there is now an additional means to obtain information about a WorkSafeBC claim, the Physiotherapy Hotline that launched mid- September. This line is designed to assist when a claim is still in a pending status on the portal. Page 4 of 5

5 If you know the name of the Claim Owner handling the claim, you should continue to call them directly with any claim s related questions. The number for the hotline is (or Physio) For any other questions, please feel free to contact us. Contact us Karen Takai Quality Assurance Supervisor Health Care Services press 2 Karen.Takai@worksafebc.com Gabrielle Jacobson Program Manager Health Care Services press 2 Gabrielle.Jacobson@worksafebc.com For more information about other health care programs at WorkSafeBC, visit us online at Page 5 of 5