By discipline: Chiropractors
On Thursday, April 3, 2014 we did a follow-up presentation to our May 3, 2013 presentation on Essentials to Management of WCB customers. The webinar is called Primary Management of Complex WCB Cases.
Advanced Case Management Strategies
Presenter: Gordon Chadwick and Dale Pitura
Date: Thursday, April 03, 2014
Subject Description: Primary Management of Complex WCB Cases
Management of the Primary Level Customer
A primer for Newer Practitioners
Presenter: David Kachan PT & Alexander Grier DC, MBA (Consultants for Sask. Workers’ Compensation Board) / Chris Drobot (Manager Health Care Services)
Date: Friday, May 3, 2013
Subject Description: chiropractors and physical therapists on Essentials to Management of WCB Customers
Chiropractors are automatically accredited with the WCB through the Saskatchewan Medical Services Branch (MSB). Once in place, chiropractors use their MSB billing number to bill the WCB for service to injured workers.
When treating WCB customers, health care providers assume certain roles and responsibilities. The WCB relies on all health care providers to ensure that:
- All workplace injuries requiring medical aid are reported promptly.
- All treatment is necessary and consistent with established agreements.
- All invoices are appropriate.
In treating WCB customers, chiropractors will:
- Comply with all requirements of the Chiropractors’ Association of Saskatchewan (CAS) and the WCB’s Practice Standards for Primary Level Chiropractic Service Providers document.
- Refer to the Support Package for Chiropractors/Physical Therapists.
- Bill the WCB in accordance with the WCB fee schedule as agreed to by the CAS.
- Demonstrate ethical practice standards on a day-to-day basis, including disclosure to any perspective WCB customer of any business relationship you may have with their employer. This allows the worker to make an informed decision regarding their choice of care provider.
The WCB annually evaluates the quality and outcomes of care provided by individual chiropractors against that of their peers and offers out-reach services as necessary to ensure consistent standards of care to injured workers. The WCB measures performance and quality of care by using the Primary Care Provider Review Process.
- Your chiropractic license includes a direct access provision, therefore you can treat customers without referral by another licensed provider.
- Within three days of your initial assessment of a customer requesting work injury related treatment, you need to forward a Chiropractor’s Initial Report (CHI) form detailing your initial findings to initiate the WCB negative-response system that confirms funding of chiropractic care. See CHI User Manual.
- When an injury claim has been disallowed or benefits terminated, you will be notified that the WCB cannot pay for further assessment or treatment.
- You will be paid for the intake assessment, the initial report and any treatment given up to the date of notification of non-coverage. The WCB will also pay reporting fees to date of notice.
- Until WCB advises of non-coverage, Medical Services Plan, other insurers, and/or the worker shall not be billed for any treatment or portion of treatment.
- Return to work and active lifestyle should generally be part of each worker’s treatment plan. For more information, see our Recovery and Return to Work brochure.
- If the injured worker’s recovery does not progress, contact the WCB to request advanced assessment and treatment, or expedited appointments, if required.
- For soft tissue injuries, refer to the Primary Chiropractic and Physical Therapy Soft Tissue Treatment Guidelines.
- When acting as the primary care provider, chiropractors may refer WCB customers to other care providers.
- Referrals must identify the medical limitations and goals and objectives of treatment.
- Please note: Referrals do not constitute authorization to treat. If you refer WCB customers to non-physician providers, the providers must contact the WCB for authorization to treat the referred customers on a file-by-file basis.
Under legislation, caregivers do not require a signed release from an injured worker in order to provide medical information to the WCB:
- WCB staff need customers’ medical records to process claims and appeals.
- The WCB may provide copies of reports to other health care providers to assist in obtaining the best possible assessments and treatments for injured workers.
In the case of an appeal, a worker’s records may be made available to an employer or others, but only with the worker’s approval.
Reporting fees are paid by the WCB where the care provider invoices the appropriate fee. If more than one report is received in the same day, only one report fee is paid. The WCB will not pay for illegible or incomplete reports.
Use the following forms to provide information about treatment, functional recovery, and response to treatment. Please fill out reports completely and legibly and fax them to WCB as quickly as possible. The WCB can not pay for illegible or incomplete reports.
- Functional Outcome Measures (FOM)
Administer the appropriate Functional Outcome Measures self report tests to WCB customers as soon as possible to help identify those who may be at risk for prolonged recovery and who would benefit from more intensive treatment. These tests include:
Only the customer’s FOM score should be submitted to the WCB, not the form itself. The score is to be reported on the Chiropractor’s Initial Report.
- Chiropractor’s Initial Report
You are required to submit a Chiropractor’s Initial Report (CHI), including the appropriate FOM score, for all injuries, including those that do not result in time off work. Where the injured worker loses time from work because of an injury, the CHI provides confirmation of disability, which allows the WCB to arrange timely payment of benefits to injured workers. Prompt reporting is important. See CHI User Manual.
- Progress and Discharge Reports
A Chiropractor’s Progress/Discharge Report (CHP), including the appropriate FOM score, should be completed after each block of 6 treatments unless the worker has been discharged, in which case, the CHP should be completed within 7 days. See CHP User Manual.
- Return to Work Report
Once a return-to-work plan has been agreed upon, the chiropractor will submit a Practitioner’s Return to Work Report (PRTW) to the WCB with copies to the primary care provider, the employer and worker to confirm the hours of work and restrictions.
- Other Reports
Copies of special reports – diagnostic, operative, and so on – should always be forwarded to the WCB. They provide the WCB with relevant information, and save the attending practitioner from preparing a separate report.
There is a two-tier fee for CHI and CHP reports: one for reports that include FOM scores and a lower fee for those that do not include the scores.
- To bill the WCB for services provided to WCB customers, see the sample Billing Summary and Adjustment to Previous Billing Summary forms. If you prefer to use a different format, make sure to include all the information requested on the CHRO form.
- The schedule of payments for services and reporting fees are established by the WCB in negotiation with the Chiropractors Association of Saskatchewan.
To expedite payment for services:
- Retain your daily record of services provided in case of an audit.
- List all services and service dates on your invoice.
- Follow the fee schedule agreed to by your professional association
- Forward the completed invoice to the WCB.
- Submit a Direct Deposit Application to receive your payments by electronic transfer.
The WCB issues payment to caregivers weekly and provides vouchers to confirm that the payments that were issued. These vouchers may include explanatory codes to provide detail regarding specific services.