Massage Therapy Services Reference Manual

Transcription

1 Massage Therapy Services Reference Manual Department WorkSafeBC Health Care Services Date January 2016 Prepared by Craig Aspinall, Program Manager Kelly Kinghorn, Quality Assurance Supervisor This manual is intended to assist with specific business processes related to doing business with WorkSafeBC. This is not a stand-alone document and it is intended that this manual be used in conjunction with the Massage Therapy Services Memorandum of Agreement, and all the related Schedules, which were effective January 1,

2 Contents PROGRAM SERVICES... 3 Overall... 3 Treatment Services... 3 Confirming WorkSafeBC Claim Status... 4 REPORTING REQUIREMENTS... 5 General Reporting... 5 COMMUNICATION... 5 General Communication... 5 Telephone Communication... 5 Chart Notes... 6 Communication with Board Officer and Attending Physician... 6 Communication with the Injured Worker... 6 Communication with the Employer... 6 WorkSafeBC Online Information... 7 INVOICES... 7 General... 7 Invoice Submission... 8 Billing WorkSafeBC via HIBC (MSP) Teleplan... 8 WorkSafeBC Injury Coding... 8 Appendices Appendix A: Massage Therapy Reporting Appendix B: Invoice (form 267) Reference Guide Appendix C: Contact Information Appendix D: WorkSafeBC Service Delivery Location (SDL) Contact Numbers Appendix E: Fee Schedule

3 PROGRAM SERVICES Overall The Massage Therapy contract offers an opportunity for Registered Massage Therapists to treat Injured Workers and to assist them in returning to their pre-injury work in a safe, timely, and durable manner. The service encourages Massage Therapists to assess and treat Injured Workers with a functional focus and assist them in reaching the physical and functional levels necessary in order to help them return to their pre-injury job. Massage Therapists must place an emphasis on return to work through the incorporation of active and functional movements into the services, unless medically and/or physically contraindicated. Massage Therapists must support the Injured Worker in returning to light and/or modified duties during their treatment if appropriate given their injury status and overall functional abilities. In addition, Massage Therapists should communicate to Injured Workers the importance of becoming re-connected to the workplace as soon as safely possible and all of the associated health benefits. Treatment Services The goal of massage therapy for WorkSafeBC is to assist Injured Workers reach the functional levels required to return to pre-injury work in a safe, durable, and timely manner. This requires the Registered Massage Therapist to have an understanding of the Injured Worker s pre-injury work hours and duties. Return to work and massage therapy treatment may occur concurrently. The Massage Therapist should provide education to the Injured Worker regarding what they can expect from the treatment, the concept of early re-activation, self management of their injury, prevention of re-injury, and the benefits of increasing function and activity. Authorization is typically not given for a worker to attend more than one type of treatment in a given time period. The Injured Worker must choose between attending physiotherapy, chiropractic or massage therapy. Massage therapy is typically not authorized when a worker is attending a treatment program. Concurrent treatments may be considered only under special circumstances and pre-approved by the Board Officer (a Board Officer is typically a WorkSafeBC Case Manager, Entitlement Officer, Vocational Rehabilitation Consultant, RTW Specialist or other as designated). A referral from a physician must be received before a Registered Massage Therapist can treat an Injured Worker. The referral must be kept in the clinical record. There are two categories of treatment: Standard Treatment The Massage Therapist can provide 1 Initial Visit and up to 12 Subsequent Treatments within the first 8 weeks after the date of injury. Board Officer approval is not required for any treatments that occur within 8 weeks from the date of injury. Board Officer approval is required for any treatments that occur later than 8 weeks after the date of injury. Treatment is limited to one massage visit per day. 3

4 There are no per session treatment time lengths; rather, the length of each session is to the clinical discretion of the RMT. Extenuating Medical Circumstances Treatment For severely injured workers that require more extensive treatment due to the medical condition (ex: lymphedema). Board Officer approval is required for any extenuating medical circumstances treatments, and for any extensions beyond 6 months of extenuating medical circumstances treatments. Confirming WorkSafeBC Claim Status WorkSafeBC will only pay for services where the claim has been accepted by WorkSafeBC and a physician s referral for Massage Therapy has been made. When booking an initial appointment, please ask the patient whether the injury is possibly work related. If so, ask for the claim number. If the Injured Worker does not yet have a claim number, please ask the worker to provide the number as soon as they receive one. You may confirm a WorkSafeBC claim status by: Checking online at Click on the view claim status, access claim status and enter the worker s claim number; ( or: Calling the WorkSafeBC Call Centre , toll-free If the status of the claim is pending, this means that a decision has not yet been made on whether it will be an accepted claim. In this circumstance the provider may choose to bill the worker privately. If the claim is subsequently accepted the provider must reimburse 100% for all Massage Therapy costs paid by the worker prior to the date the claim was accepted and bill WorkSafeBC directly at contracted rates. Treatment of Non-Claim Related Injuries The RMT should treat the area of the body that is accepted as part of the WorkSafeBC claim only. If the worker would like the RMT to treat a different area of the body (aside from the area accepted as part of their claim), the RMT can do-so and bill the worker privately for those services. The worker should be made aware that the treatment to the non-claim related area of the body will not be reimbursed by WorkSafeBC. For example: In a scenario where a client is receiving treatment for a WorkSafeBC shouler injury claim, but would like an additional 30 minutes for treatment to an un-related lower body condition, the RMT would bill WorkSafeBC (according to the fee schedule) for the shoulder injury and bill the client privately for the lower body condition. The RMT would maintain separate charting, documentation and billing for the WorkSafeBC injury and non-claim related body condition. 4

5 REPORTING REQUIREMENTS General Reporting All documents that are submitted must contain the following information on each page of the document: o Injured Worker's name o Injured Worker's claim number o Document name and page number All reports must be submitted using the guidelines found in this manual. For assistance with Program related business process questions for reporting, please contact Health Care Services at WorkSafeBC at (604) or toll-free at For details on how to complete the report, please refer to Appendix A. COMMUNICATION General Communication The following are situations that require immediate disclosure to the appropriate WorkSafeBC staff member: Any implicit or explicit threat towards a WorkSafeBC staff member or property; and/or Any statement or action of harm directed towards another individual. Where any accident or critical incident occurs, the Board Officer and Attending Physician must be notified immediately by telephone and a written incident report must be submitted to WorkSafeBC. In situations where the incident results in the Injured Worker requiring emergency care, the Contractor must contact the WorkSafeBC Health Care Services Program Manager within one (1) business day. The Massage Therapist will promptly report to WorkSafeBC any injury to an Injured Worker occurring during treatment. When reporting one of the above, the seriousness of intent should also be communicated. Contact the Quality Assurance Supervisor If in doubt of the appropriate person to contact. If an interpreter is required for any communication with an Injured Worker, please contact the Board Officer or Service Coordinator associated with the claim for assistance in arranging this. Telephone Communication If the Massage Therapist is involved in communicating meaningful details on an Injured Worker treatment, return to work plans, or other related issues then they may invoice for this time using fee code Communication could be through a detailed message or could involve a conversation with a Health Care Provider, a Board Officer, or an employer. This communication must be documented, and billing should not occur for routine, administrative and or quality assurance issues. 5

6 Chart Notes A Massage Therapist may be requested to provide a copy of an Injured Worker s clinical chart notes in order to assist a Board Officer in making a decision on the claim. The expectation is that these notes are provided in a timely fashion (within 2 business days from the time of the request), and that they are legible. If the chart notes are illegible, then it is expected that the Massage Therapist provide a legible copy to WorkSafeBC at no additional cost. Communication with Board Officer and Attending Physician All reports sent to the worker s Attending Physician must be copied to WorkSafeBC. If the Massage Therapist s assessment identifies findings that are inconsistent with the injury on the accepted claim, the Massage Therapist must notify the Board Officer and Attending Physician within three (3) business day of the assessment. The Board Officer will then determine whether or not the findings are part of the claim. Recommendations for RTW, further medical investigations/referrals, medical supplies / equipment and treatment plan etc. should be discussed with the Board Officer prior to advising the worker or documenting in a report. This ensures that the recommendations can take into account the medical information available on the file and, if needed, clinical opinion of the appropriate health professional Communication with the Injured Worker The expectation is that Massage Therapy Providers are communicating with the Injured Worker in regards to the findings of their assessment, the recommended treatment plan, and the overall model of Massage Therapy services that they are providing. Specific questions regarding the Injured Worker s benefits or issues relating to entitlement on a claim should be directed to the Board Officer Communication with the Employer The Massage Therapist must obtain the Injured Worker s consent prior to speaking with the employer. When obtaining consent, the Massage Therapist must inform the Worker that they are going to be contacting the employer in order to discuss critical job demands and RTW opportunities in addition to the Worker s current physical limitations. If the Worker does not provide consent for the Massage Therapist to speak with the employer, the Massage Therapist should contact the Board Officerto discuss. When speaking with the employer, the conversation should be limited to: What the Injured Worker s current critical job demands are What the claim has been accepted for e.g. shoulder injury The current functional abilities and physical limitations that the Worker presents with in relation to their injury 6

7 The return to work barriers that these physical limitations pose to the Worker returning to work When speaking with the employer, the Massage Therapist should NOT discuss: Any additional details about what the claim is for e.g. medical details about the injury Any non-compensable issues i.e. issues not directly related to the claim Information pertaining to the Worker s prior medical history If the employer asks questions and the Massage Therapist is unsure as to what they should or shouldn t respond to, the Therapist should err on the side of caution and not respond until they have discussed the questions with either the Board Officer or have contacted WorkSafeBC s FIPPA office at WorkSafeBC Online Information WorkSafeBC has a Health Care Provider site that can be accessed online at: The Health Care Provider section is designed to help health care providers better understand our programs, services and business process. Massage Therapists and other health care providers can access useful information tailored specifically to their practice, including: The status of a claim Invoice payment status Resources such as brochures and post surgical rehabilitation guidelines INVOICES Invoices for services must be received within 90 days following the date of service. Invoices received beyond 90 days will not be paid unless there are exceptional circumstances to account for the delay in billing. For assistance with Program related business process questions for invoicing, please contact Health Care Services at WorkSafeBC at (604) General It is the Massage Therapist s responsibility to confirm the worker s claim status. If the claim is pending at the initial visit, it is up to the Massage Therapy Provider as to how payment is collected (i.e. directly from the Injured Worker or awaiting a claim s decision). Treatment provided during this pending time will not be paid by WorkSafeBC if the claim is subsequently disallowed. When a pending status becomes accepted, the Massage Therapy Provider must reimburse the worker 100% for all massage costs paid prior to the date the claim was accepted, and invoice WorkSafeBC directly according to the fee amounts in Schedule B of the Agreement. A Massage Therapist shall not invoice WorkSafeBC for missed, late, or cancelled appointments under any circumstances. A Massage Therapist must not charge any additional fees to an Injured Worker who has a claim accepted by WorkSafeBC (e.g. therabands, user fees, administrative fees, ice pack, etc.). 7

8 Invoice Submission The preferred method of invoice submission to WorkSafeBC for Massage Therapy Services is by electronic submission via HIBC (MSP) Teleplan. Invoice for Treatment Services (Form 267) should be used if you choose to fax or mail invoices to WorkSafeBC (form 267 at If a worker does not have a PHN, please fax the invoice directly to Payment Services at (604) GST (where applicable) must be entered as a separate line item for each date of service on the invoice using fee code 19332: Good and Service Tax(GST) Billing WorkSafeBC via HIBC (MSP) Teleplan As Teleplan is an automated system, the information you provide must be correct and consistent before the system will allow payment for your services. The date of service, payee number, and form fee item submitted must exactly match the date of service, payee number, and form fee item on the invoice you transmit to us. If they do not match, your invoice will be rejected and you will need to correct the information and resubmit the invoice. To submit invoices via Teleplan, you need clinic billing software that is compatible with Teleplan. For more information, contact a medical software vendor. Alternately, you can submit through Teleplan by using a service bureau. A BK explanatory code tells you that the WorkSafeBC has received your submission and is currently making a decision on it. Some complex claims can take more than 60 days to make an entitlement decision, so your patience is appreciated. A Refusal code AA means that the patient does not have a PHN and/or the patient is not a British Columbia resident. If the worker does not have a personal health number, please write that information on the Form 267 Invoice for Treatment Services and fax the invoice directly to Payment Services at (604) Further details on Explanatory codes can be found on line at: If a payment has been rejected either by Teleplan or by WorkSafeBC it is the Provider s responsibility to follow-up on the reason for this rejection in a timely manner. WorkSafeBC Injury Coding WorkSafeBC has adopted the Canadian WorkSafeBC injury coding standards. This is a key element for case management and early intervention. Injury coding consists of these components: Service location codes Side of body codes Body part codes Nature of injury codes 8

9 Diagnostic codes (ICD-9) (access online) This coding is mandatory on all invoices submitted via MSP Teleplan. It allows for expedited matching of invoices to claims, resulting in timely payment. Codes can be accessed on line at: under health care providers health care practitioners massage therapists. 9

10 Appendices Appendix A: Massage Therapy Reporting The Massage Treatment Report is submitted on a template (form 83D48) that is downloaded from the website: A Massage Treatment Report is required within 5 business days of the initial visit, when requesting an extension for regular Treatment beyond eight (8) weeks of the Injured Worker s date of injury, for Extenuating Medical Circumstances treatment beyond six (6) months, or as requested by WorkSafeBC. If requested by WorkSafeBC, report must be received by WorkSafeBC within five (5) business days from the date of the request. For invoicing purposes the date of request is considered day zero (0). Date of Report Date of Service Report Type Enter the date the report is submitted Enter the date of the initial visit (or the date of the extension request, or the date the report was requested by WorkSafeBC) Indicate by ticking the appropriate box whether the report is an: Initial Visit Report (submitted after the initial visit) Progress Report (submitted every 6 months of approved treatment) Other (to request authorization for further treatment, home visits, or extenuating medical circumstances) Provider Information Name Payee number (vendor number) Mailing Address Clinic phone number Clinic fax number Enter the name of the treating Massage Therapist(s) Enter the MSP Practitioner number of the treating RMT or the Clinic Payee Enter the physical address of the clinic/facility where the service was delivered. Enter the phone number of the clinic where the Worker is attending treatment. Enter the fax number of the clinic where the Worker is attending treatment. Worker Information: Worker last name First name WorkSafeBC claim number Occupation Enter the Worker s last name. If possible, it should match the name on the Worker s British Columbia CareCard Enter the Worker s first name. If possible, it should match the name on the Worker s British Columbia CareCard Enter the WorkSafeBC claim number specific to this injury. You can confirm the claim number by contacting the WorkSafeBC Call Centre ( ) Enter the title of the Worker s Occupation 10

11 Date of injury Clinical Report Clinical Report The date when the work-related injury occurred. You may wish to check this date by accessing Online Claim Status through Reports should include at least the following information: Injured Worker s current clinical status; An outline of the treatment goals, including the estimated number and frequency of visits. The expected duration of treatment and discharge date; The expected treatment outcome and recommendations; A rational for continued treatment should be included in all reports requesting ongoing treatment. Name of treating therapist Reports can also include: Any significant subjective comments that relate to the Worker s injury Any significant clinical or objective findings that relate to the Worker s injury accepted on the claim. Any factors that you anticipate may delay recovery as well as any additional comments relevant to this Worker s current status. 11

12 Appendix B: Invoice (form 267) Reference Guide Please note: The payee number can be your MSP practitioner number for an individual therapist. Clinics could also obtain a payee number for the clinic. The details that correspond to this payee number will be used to issue payment. If you are an individual without a practitioner number, or a clinic that wants to obtain a payee number, you will need to contact HIBC. Payment Information Form Field Invoice Number Invoice Date Provider Name Practitioner Number Payee Number Mailing address for payment Telephone Number Fax Number Description A number chosen by the provider to identify the invoice Enter the date of the invoice. Invoice date must be after the date of service. Enter the name of the clinic that provided service to the worker. Enter the practitioner number of the Registered Massage Therapist who provided service to the worker. The practitioner number may be the same as the payee number. Enter either the Payee number for the clinic or the treating Registered Massage Therapist s practitioner number, if payment should be issued to the practitioner directly. Payment will be issued to the account details for this payee number; payment cannot be made without this information. Enter the mailing address for that corresponds to the payee number. Include street location, city, province and postal code. You may use a stamp if filling out a paper form. Enter the telephone number, including the area code, of the clinic where service was provided to the worker. Enter the fax number, including the area code, of the clinic where service was provided to the worker. Service Recipient Information Form Field Service Recipient s last name Service Recipient s first name Gender Birth Date Personal health number WorkSafeBC Claim number Date of Injury Description Enter the worker s last name. If possible, it should match the name on the worker s British Columbia CareCard. Enter the worker s first name. Initials should not be used. If possible, it should match the name on the worker s British Columbia CareCard. Select male or female. Enter the birth date of the injured worker. Enter the worker s Personal Health Number as shown on the British Columbia CareCard. If the worker does not have a PHN, indicate this on the form. Enter the WorkSafeBC claim number specific to this injury. To confirm the claim number by contacting the WorkSafeBC Call Centre, please ensure you have the correct injury date, birth date and PHN for the worker. The date when the work related injury occurred. 12

13 Injury Information This coding is mandatory on all invoices submitted via MSP Teleplan. It allows for expedited matching of invoices to claims, resulting in timely payment. Form Field Diagnostic Code (ICD9) Side of Body Code Body Part Code Nature of Injury Code Description These codes can be found on online at: These codes can be found on online at: These codes can be found on online at: These codes can be found on online at: Service Information GST (where applicable) must be entered as a separate line item for each date of service on the invoice using fee code 19332: Good and Service Tax(GST) Form Field Service Location Code Date of Service Fee Code Amount Service Description Number of service units Description See Appendix D Indicate the specific date(s) Massage Therapy service was provided to the injured worker. Indicate the fee code for the specific Massage Therapy service provided, as outlined in the Fee Schedule in Appendix E. Indicate the fee amount(s) for the specific Massage Therapy service provided, as outlined in the Fee Schedule in Appendix E. Describe the specific type of treatment provided to the Injured Worker for each treatment date of service as stated in the Fee Schedule. The number of service units is 1 for each initial visit and subsequent visit. 13

14 Appendix C: Contact Information Program and service inquiries Health Care Services Lower Mainland Toll-free ext HCSINQU@worksafebc.com Provider Referrals Lower Mainland: Toll-free: Fax: Toll-free Fax: General claim or entitlement inquiries Lower Mainland: Toll-free: Billing and payment inquiries Payment Services Lower Mainland: Toll-free: Contract inquiries Purchasing Services Lower Mainland: Toll free: , local

15 Appendix D: WorkSafeBC Service Delivery Location (SDL) Contact Numbers Each SDL (Service Delivery Location) represents a WorkSafeBC office that provides prevention, claims, account management and assessment services to workers and employers of British Columbia, primarily directed to where the employer is located in the province and often based on the employer s industry. Each WorkSafeBC SDL provides comprehensive and integrated day-to-day customer service for workers, employers and stakeholders. The SDL contact numbers are included below to be used in the case of urgent circumstance where the provider may want to reach WorkSafeBC but the Board Officer is not available for contact. SDL Phone Number Toll Free Abbotsford Burnaby Coquitlam Courtenay Cranbrook Kamloops Kelowna Nanaimo Nelson Prince George Special Care Services Surrey Terrace North Vancouver Victoria

16 Appendix E: Fee Schedule Fee Code Service Business Rules Jan 1, Dec 31, Initial Visit with Massage Treatment Report Subsequent Treatment Massage Treatment Report Requested by WorkSafeBC Telephone Consultation with Board Officer Limit one (1) per payee per claim. Flat fee inclusive of service and timely report. Deduction of $27.00 timely Initial Visit report fee will be applied if report received more than five (5) business days from the initial visit. For invoicing purposes the date of the initial visit is considered day zero 0. Any massage visits beyond 8 weeks following the workers date of injury must be approved by the Board Officer. Up to 12 subsequent visits can be offered within the first 8 weeks following the workers date of injury. Any massage visits beyond 8 weeks following the workers date of injury must be approved by the Board Officer. Limit one (1) per payee per day per accepted claim. Required for regular Treatment beyond eight (8) weeks of worker s date of injury, for Extenuating Medical Circumstances treatment beyond six (6) months, or as requested by WorkSafeBC. If requested by WorkSafeBC, report must be received by WorkSafeBC within five (5) business days from the date of the request. For invoicing purposes the date of request is considered day zero (0). The RMT shall not be reimbursed for incomplete reports Billable for conversation time only for discussions regarding treatment related issues or return to work and must be documented in clinical notes. Billable for consultations up to fifteen (15) minutes per Service-Unit. Limit one (1) per payee per accepted claim per day. $70.00 (inclusive of $27.00 report fee) Jan 1, 2019 Dec 31, 2020 $75.00 (inclusive of $27.00 report fee) $43.00 $45.00 $27.00 per Report Not billable for discussion of administrative, invoicing or performance issues Photocopies Payable when requested by WorkSafeBC for copies of clinical records $25.00 Flat fee Extenuating Medical Circumstances Goods and Services Tax (GST) One (1) Service-Unit equals fifteen (15) minutes of treatment. Must receive prior approval from the Board Officer. Maximum of eight (8) Service-Units (six (6) treatment service units plus two (2) travel). Billable if the Massage Treatment Report is received before the Initial Visit and before the end of the six (6) month period. Where applicable, show PST and GST separately for each line item (not as a lump sum) on an invoice; Include the RMT s GST registration number. $27.00 per Report $25.00 $25.00 $25.00 Flat fee $18.00 $18.00

17 Registered Massage Therapy Services Reference Manual Page 17 of 17