Certificate of Capacity in General Practice. Practice Managers Networking Event

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1 The Health Benefits of Safe Work program and the implementation of the Certificate of Capacity in General Practice Practice Managers Networking Event Annie Campbell, Program Consultant. NHV

2 Health Benefits of Safe Work program Learning Objectives To be aware of the key messages of the Health Benefits of Safe work program. To develop an understanding of the rationale behind the revised Certificate of Capacity. To be aware of what your practice can do to ensure ease of transition in using the Certificate of capacity. 2

3 Health Benefits of Safe Work program NHV is working in association with Health and Disability Strategy Group (HDSG) a collaboration between the TAC and WorkSafe to deliver the HBoSW program to general practice. 3

4 The Health Benefits of Safe Work 4

5 The role of GPs in realising the Health Benefits of Work Evidence-based messages: Work is an important part of rehabilitation Work is a therapeutic intervention Typically, waiting for recovery, delays recovery Staying away from work may lead to poorer health Employer-supported, early return to work helps recovery 5

6 The role of GPs in realising the Health Benefits of Work Practical ways to support return to work: Recommend a graduated increase in activity Set a timeline for return to work Talk to the employer (preferably while the patient is with you), especially about how to work duties Collaboratively identify obstacles and solutions Being clear about what health care can and can t achieve, and Identifying possible sources of support 6

7 Certificate of Capacity 7

8 The combined Certificate of Capacity design As of 1 st March 2015, the combined TAC/WorkSafe Certificate of Capacity will replace all previous versions The purpose of which is to: Improve information exchange and encourage a positive focus on what an injured worker can do Support the conversation between GPs and their patients about returning to safe and sustainable work Reduce the number of forms certifiers use through alignment across the TAC and Worksafe Align with the workflow of a consultation, including integration into medical software 8

9 Alignment of forms for TAC and WorkSafe 9

10 Introduction: Combined Certificate of Capacity 10

11 Where to access the combined Certificate of Capacity 1. Available on TAC or WorkSafe websites as smart form or word doc: tac.vic.gov.au/certificate worksafe.vic.gov.au/certificate 2. Order printed forms via Print Media Group On company letter head request FOR-844 Certificate of Capacity Fax Medical Software As a supplied template in clinical software 11

12 Software packages that have the combined Certificate of Capacity Clinical software Release date Type Name of template in software Supplied template in Best Practice word processer Best Practice August 2014 Simple user guide is available at: tac.vic.gov.au/certificate vwa.vic.gov.au/certificate TAC & VWA - Certificate of Capacity Supplied template in letter writer Medical Director Genie Medtech32 Simple user guide is available at: tac.vic.gov.au/certificate vwa.vic.gov.au/certificate Supplied template Supplied template VIC WorkCover & TAC Certificate of Capacity StatHealthSystems July 2014 Supplied template Practix SmartSoft Supplied template Supplied template ZedMed August 2014 Available for download via the private support area of the ZedMed Website. Under Clinical Templates, State specific forms VIC. TAC WorkCover Certificate of Capacity Medinet Oct 2014 Available as download on Abaki website VIC WorkCover & TAC Certificate of Capacity Profile Feb 2015 Available in Profile version 7.10 as supplied template Victorian Certificate of Capacity 12

13 Why is a combined Certificate of Capacity required? to enable the payment of income benefits to TAC clients and injured workers to determine capacity for work to communicate with the key people supporting your patient to return to work 13

14 Certification of Work Capacity Must be on medical grounds only Must be related to the compensable injury Should reflect the patient s capacity what the patient can do, rather than the availability of suitable employment An appropriate certificate is an enabling tool which can trigger support services for the injured patient 14

15 What happens with the certificate? The original is taken by the patient and a copy is kept by the certifier For WorkSafe the original certificate should be taken to the employer, who in turn should send it to the Agent For TAC: the certificate should be sent by the TAC client or GP practice to the TAC directly NB. Faxed certificates are accepted if received in full. 15

16 Legal requirements for Worksafe and TAC patients Injured workers (WorkSafe) must actively participate in returning to suitable work or pre-injury employment when they have capacity to do so and when offered (this includes participation in Occupational Rehabilitation if this service is provided.) Some compensation payments can be ceased or reduced if a TAC client does not accept a reasonable offer of suitable employment or a reasonable offer or rehabilitation or vocational rehabilitation services. 16

17 Is your General Practice ready? 17

18 General Practice Readiness Checklist? NHV have developed an interactive checklist designed to assist with the implementation of the combined Certificate of Capacity in your practice 18

19 TAC/Worksafe Scheme Information 19

20 Roles The TAC s role is to: promote road safety in Victoria pay for treatment and benefits for people injured in transport accidents Funding used by the TAC comes from payments made by Victorian motorists when they register their vehicles each year with VicRoads The TAC receives approximately 17,000 claims per year 20

21 Roles WorkSafe s role is to: enforce OH&S laws to prevent workplace injuries and illness provide workplace injury insurance manage the Victorian WorkCover injury insurance scheme through authorised Worksafe Agents The WorkSafe authorised Agents manage: employers WorkCover injury insurance policies and injured workers compensation claims There are approximately 30,000 WorkCover claims per year 21

22 Roles 5 Agents are authorised by the WorkSafe to manage injured workers claims Note- The TAC (Community Integration Program) also manage a small number of seriously injured claims on behalf of VWA 22

23 Roles o Both are no fault schemes o Legislation guides the TAC and the WorkSafe in the types of benefits it can pay and any conditions that apply Transport Accident Commission: - the Transport Accident Act 1986 WorkSafe: - the Accident Compensation Act Accident Compensation (WorkCover Insurance) Act Workplace Injury Rehabilitation and Compensation Act 2013 o The TAC and WorkSafe policies and work practices are guided by this legislation 23

24 Provision and payment for services The TAC and WorkSafe can pay the reasonable costs of medical services required by TAC clients and injured workers as a result of the transport accident or work related injury/illness. The costs are paid in line with the MBS unless otherwise specified in TAC or WorkSafe policies A list of the reimbursement rates are available on the websites TAC Medical Services Reimbursement Rates VWA Medical Services- Reimbursement Rates 24

25 Payment for Medical services Invoices should be sent directly, by mail, to the WorkSafe Agent managing the claim or directly to the TAC for transport accident claims. For the invoice to be processed the patient must have an accepted claim & their *excess must be met. Invoices must include: Patient s claim number Patient details - name, address, date of birth Billing details Provider and service details Refer to the Invoicing guidelines for medical practitioners 25

26 Working with TAC/Worksafe The excess is the initial amount payable by patient (TAC claims) or employer (WorkSafe claims) for the reasonable costs of medical services. TAC medical excess WorkSafe employer excess How much is excess $623* $660* How is the excess paid? Patient pays for medical services until the excess is reached. Patient submits receipts to employer for reimbursement or GP can send invoice directly to employer 26

27 How are TAC accounts paid The TAC s CONNECT area is responsible for the processing of accounts TAC payment officers process accounts TAC claims staff are responsible for making decisions and determining entitlements For enquiries relating to account payments contact: TAC your patient s TAC Claims Manager 27

28 How are Worksafe accounts paid The Agent s Accounts Processing Team manages the payment of invoices The Case Manager is responsible for making decisions and determining entitlements For enquiries relating to account payments contact: - Agent Customer Service - your patient s Case Manager at the managing Agent - WorkSafe Advisory Service 28

29 Payments Providers can choose between daily, weekly, fortnightly and monthly payments cycles Providers have a choice between EFT and cheque payment methods EFT is the preferable option Remittance notices are the method of communication that the TAC and WorkSafe use to advise providers of the status of their accounts 29

30 Communication between GPs, Employers and the TAC and Worksafe It is lawful for the TAC and WorkSafe (and their agents) to collect information relevant to a TAC or VWA claim from healthcare professionals. It is lawful for healthcare professionals to disclose an individual s health information to the TAC and WorkSafe where: the individual has consented through completing the applicable claim form; and the health information provided is relevant to the claim. 30

31 Patient consent- GP communication with the employer GPs should establish their patient s consent in accordance with professional obligations Employers must obtain a worker s consent to contact the treating health practitioner. Discussion should be for the purpose of assisting the patient s rehabilitation and return to work and relevant to the TAC or WorkSafe claim. Obtain independent legal advice for guidance relating to specific scenarios. 31

32 Treating Health Practitioner (THP) Reports A THP report can be requested by the TAC or WorkSafe Agent to gain information relating to the patient s work related or transport accident injury or illness A THP report will provide information to assist in: determining eligibility for entitlements reviewing ongoing medical and health needs the management of rehabilitation and return to work needs NB. The Accident Compensation Conciliation Service, Medical Panel or other legal representatives can also request a THP report and The report needs to address the requested questions and cannot only be a copy of clinical notes or a previously submitted report 32

33 THP reports To assist with a timely decision on a patient s treatment and services a report should be returned to: the TAC within 10 working days of receiving the request the relevant WorkSafe Agent within 10 working days of receiving the request To ensure timely processing of payment the invoice should: Include the item code and amount agreed by the TAC or WorkSafe Agent If not, please contact the TAC or WorkSafe agent to discuss 33

34 More information TAC tac.vic.gov.au WorkSafe Worksafe.vic.gov.au (03) or Networking Health Victoria (NHV)

35 Thank you Annie Campbell If you have any other queries, please contact Network Health Victoria on or (03)