service provider guide working with ICBC s Rehabilitation Department

Transcription

1 service provider guide working with ICBC s Rehabilitation Department

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3 table of contents I Introduction...3 II Part 7 Benefits General Information...4 Role of Rehabilitation Coordinator...6 Role of Rehabilitation Benefits Administrator...7 Role of Rehabilitation Benefits Assistant...8 III Performance Standards...9 IV Procedures Referrals...10 Authorization & Assessment Reports Billing & Accounts...15 Supplier System Approval Termination & Closure...19 Service Provider Evaluations V Appendix Rehabilitation Progress Report Invoice Sample Supplier Approval Form Service Provider Evaluation Form

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5 introduction The Insurance Corporation of British Columbia believes that in today s economic climate, efficient utilization of health-related funds and services is critical. The current focus of rehabilitation is the management of cost-effective programs, which offer high quality service and outcome based results. The Rehabilitation Department s mandate is to provide financial assistance to develop and coordinate individually designed rehab programs for persons who have sustained catastrophic injuries as a result of a crash in order to help them reach their highest reasonable level of self-sufficiency. This will be done through the utilization of community services in a cost-effective manner. ICBC believes that delivery of rehabilitative services to injured clients can be achieved in a cost-efficient manner without compromising quality, while at the same time promoting client independence. This guide is intended to inform Service Providers of our administrative requirements, policies and processes, in order that they can provide our clients with effective rehabilitation. 3

6 general information part 7 benefits The Insurance Corporation of British Columbia is a Crown Corporation, formed by the provincial government in With its compulsory scheme of insurance, the Insurance (Vehicle) Act and Insurance (Vehicle) Regulation together constitute the statutory contract referred to as Autoplan. Part 7, or No-Fault Accident Benefits, form a compulsory part of Autoplan coverage. Regardless of who is deemed to be at fault in an auto accident, Autoplan pays accident benefits for injury to all occupants of the vehicle if it is licensed and insured in British Columbia. Autoplan also pays accident benefits to a named insured as well as to members of the named insured s household who are injured in an auto accident while riding in a vehicle or as a pedestrian or a cyclist. In addition, accident benefit payments apply to any cyclist or pedestrian who is injured as a result of a collision with a vehicle that is insured in British Columbia, provided that the accident occurs within Canada. Part 7 Benefits are subject to certain limitations imposed by the Insurance (Vehicle) Regulation. They provide payment of reasonable medical and rehabilitation expenses, weekly indemnity for total disability, funeral expenses and death benefits. The current maximum allowable for medical and rehabilitation expenses is $150,000 per accident, for the lifetime of each injured person. In addition, an employed person may claim up to a maximum of $300 per week for the period of total disability. The staff of the Rehabilitation Department of ICBC helps those who have suffered a catastrophic and/or long term injury in an auto crash, where entitlement is available under Part 7. The rehabilitation program provides payment for the medical and vocational assistance necessary for the injured person to achieve, in the shortest practical time, the highest reasonable level of gainful employment or selfsufficiency that, allowing for the permanent effects of the injuries is reasonably achievable. 4

7 general information part 7 benefits It is incumbent upon the Rehabilitation Department to ensure prudent use of the Part 7 funds on behalf of the injured insured and the premium payers of the province. NOTE: Any contradiction, dispute or difference between contents of this guide and the applicable Acts or Regulations shall be resolved only by reference to that Act or Regulation. 5

8 rehabilitation coordinator role The Rehabilitation Coordinators perform case coordination functions. They are responsible for coordinating cost-effective and efficient service delivery to people with multiple needs resulting from severe disabilities or catastrophic injuries from a crash. In addition, they also perform adjudication and payment functions. In this capacity, they are responsible for determining an insured s coverage and entitlement under Part 7 (Accident Benefits) of the Insurance (Vehicle) Regulation. Timely and appropriate intervention can achieve the best outcome in the shortest possible time. To make the necessary connections and ensure that the clients receive a continuum of care within the context of the Part 7 coverage, the Rehabilitation Coordinators must have a working knowledge of disabling conditions, appropriate interventions, and available resources. They must be able to assess, plan, implement, coordinate, monitor and evaluate options and services that meet a client s needs. The Rehabilitation Coordinators do not perform any diagnostic assessments and do not recommend treatment. However, they are involved in the development of an individualized rehabilitation plan for a client, in concert with the rehabilitation team, and according to the provisions of Part 7. The Rehabilitation Coordinators work with the medical, rehabilitation, other health care and legal professionals and employers, to implement these plans. Along with the team, the Rehabilitation Coordinators may identify required services and may contract, monitor, evaluate and terminate such services. The Rehabilitation Coordinators act as consultants to adjusters and assist claim centers in identifying appropriate injury referrals to the department. They ensure provision and payment of appropriate equipment and services in accordance with corporate policies, procedures and standards. The Rehabilitation Department recognizes the need to keep abreast of new advances and the Rehabilitation Coordinators strive to familiarize themselves with new technology and developments in the field of rehabilitation. 6 The Rehabilitation Coordinators are responsible for a defined geographic area.

9 rehabilitation benefits administration role The Rehabilitation Benefits Administrator (R.B.A.) carries on with the handling of the file where the Rehabilitation Coordinator has left off. The R.B.A. is responsible for administering long term catastrophic files such that the rehabilitation plans are monitored, evaluated, maintained and/or adjusted as the insured s condition improves or deteriorates. This involves approving the ongoing medical, vocational and rehabilitation accounts for clients within an established rehabilitation plan. The R.B.A. monitors the progress of the plan. In addition, the R.B.A. initiates and responds to correspondence relating to the insured, makes adjustment to the plan as necessary based on reports received from the insured and other professionals involved with the client s rehabilitation. If appropriate, the R.B.A. identifies, evaluates, and settles Part 7 Benefits by cash settlement, or conclusion of the rehabilitation program. 7

10 rehabilitation benefit assistant s role The Rehabilitation Benefits Assistant s (R.B.A.) function is to maintain the catastrophic files within the Rehabilitation Department. This involves payments within the established rehabilitation plan, monitoring progress and initiating and responding to correspondence on files. The R.B.A. also evaluates Part 7 benefit funding requests as appropriate for the identified needs of the insured. Both positions are required to have a working knowledge of the coverage available under Part 7 and the ability to apply and explain insured s entitlements under this section. 8

11 performance standards The Service Provider is obligated to maintain technical/ professional competency at a level where the client receives the highest quality of service that the Provider is capable of offering. A complete application package is required of each Service Provider. Any staffing changes should be communicated to the Rehabilitation Coordinator/R.B.A. handling the case. The Service Provider shall render only those services that he/she is competent and qualified to perform and which ICBC has requested. Services will be provided in a timely fashion and shall correspond to the purpose of the referral. Reports, which reflect an objective, independent opinion based on factual determinations within the Provider s area of expertise, shall be submitted in a timely fashion. The Service Provider is obligated to withdraw from a professional relationship if it is believed his/her participation will result in violation of the ethical standards of his/her professional discipline. Before providing services to the client, the Service Provider shall formulate a stated rationale outlining identified objectives or purposes, timeframes and costs. The Service Provider shall only bill for authorized services rendered. ICBC may conduct an audit of the Service Provider s financial and client records at any time to confirm the accuracy of billings to ICBC to confirm that services have been provided as reported. The Service Provider will cooperate with any such audit, and must deliver any records requested by ICBC to the location specified by ICBC within two (2) business days of a request being made. If records are not delivered as requested, ICBC may attend the business premises of the Service Provider to inspect and take copies of the records and the Service Provider will pay to ICBC the reasonable cost of the inspection. The Service Provider shall discharge the client in a timely fashion. 9

12 referral procedure The Service Provider should follow the following procedures and guidelines when ICBC is funding a client for service: The Service Provider will not receive any payment for services unless the Service Provider has obtained written approval of such service request from ICBC prior to commencement of services. ICBC will provide the Service Provider with written confirmation of the referral outlining specific instructions with available relevant client medical records. The Service Provider shall make contact with the client within one week of referral, unless otherwise agreed upon by ICBC. 3. The Service Provider shall provide written/verbal acknowledgement of the referral and the date of client contact, within two weeks from referral, at no charge to ICBC The Service Provider shall submit an initial evaluation report/ plan of action, in writing to ICBC, within one month of referral. If an assessment cannot be completed within that required time frame, agreement must be made with the Rehabilitation Coordinator/Rehabilitation Benefits Administrator at time of referral. Referral for service gives automatic approval to undertake an initial assessment up to the development and submission of a rehabilitation plan or as otherwise specified by ICBC s Rehabilitation Department. Release of medical, legal or any other documents is to be at the discretion of ICBC. All information supplied by ICBC is confidential and should only be used by the Service Provider for the assessment and development of a rehabilitation plan. 10

13 authorization and assessment In order to ensure that the Service Provider will receive payment for additional services, approval from ICBC must be obtained prior to commencement of service. Initial referral from ICBC allows automatic approval to undertake initial assessment up to the development and submission of a rehabilitation plan or as otherwise specified in the initial referral. Initial assessment and the rehabilitation plan should be forwarded to ICBC within thirty (30) days of referral. If this time frame cannot be met, agreement must be made with the Rehabilitation Coordinator/Rehabilitation Benefits Administrator at time of referral. Cost estimate for service must be submitted to ICBC with the initial assessment and plan. ICBC shall acknowledge report and approve plan and funding by signing off copy of recommendation/cost estimate and returning to Service Provider within three (3) weeks. Verbal authorization may be provided if there is an urgency involved, followed by written confirmation. No commitments will be made to client by Service Provider unless authorized by ICBC. Approval by ICBC is required on any changes in the program or hours of service, which have an effect on overall time frames and/or cost of service delivery. ICBC approval is required in advance if service is recommended from a Service Provider other than the Provider originally retained. Continuity of Service Provider is important in the rehabilitation process. Concurrent handling of a case by more than one Provider must be discussed with the Rehabilitation Coordinator/ Rehabilitation Benefits Administrator, and pre-approval obtained. 11

14 authorization and assessment Any reports or testing completed or obtained by the Service Provider must be disclosed to ICBC. Any rehabilitation plans or assessments will include goals, action plans, time frames, activities, contact, names of Service Provider, and cost estimate. ICBC is a partner with the B.C. Government s Purchasing Commission in a contractual agreement, known as the Corporate Supply Arrangement (CSA), (formerly known as the Master Standing Offer MSO ) with various medical equipment suppliers in all regions of the province. Occupational therapists or physiotherapists prescribing medical and rehab equipment need to provide the Rehabilitation Coordinator with a completed specification sheet and once they receive confirmation of coverage, obtain a quote from an approved CSA supplier. The therapist or supplier then provides the quote to the Rehabilitation Coordinator for approval. While health care services are generally not taxable, tax should be included as applicable. 12

15 reports General guide all reports All reports submitted to ICBC shall be in original form. (Fax document is acceptable, but should be followed by original). All reports shall contain claim/case identification information, date and reason for referral and date of report preparation, i.e. dictation v. typing. Release of any reports, documents, etc., to any other party shall be done only with prior written approval from ICBC. Reports shall contain indications of client s attendance, motivation, behaviour as well as any special skills or problems that the client may have that were not previously identified. Information sources used including reports, consultations, personal interviews, etc. shall be included in the report. Reports should reflect the individual problems of the client and should not be made up of lengthy stock phrases and jargon. Assessment report Assessment report shall not repeat information supplied by ICBC, for example, detailed medical history, details of accident, etc. Assessment report shall contain the evaluation process and methods used to arrive at the conclusions and recommendations. Assessment report shall contain proposed services/strategies, time frames and cost estimate related specifically to the achievement of the defined goals and objectives. Assessment report shall contain evidence of client involvement and understanding of the process relating to the achievement of the identified goals. 13

16 reports Progress report: (See Appendix A) Progress report shall be submitted on ICBC s request only and the frequency of reporting is at the sole discretion of ICBC. (Frequency of reports should be determined at onset of referral. It is understood that active rehabilitation cases should have regular progress reports). Progress reports need to include the content as defined by the sample progress report in Appendix A. When a progress report is required, the report shall contain clear and concise documentation of activities; relating progress to expected outcome. 14

17 billing & accounts All invoices shall include the following information: Name of injured client ICBC claim number Supplier account number (see section on Supplier System) Total cost of program to-date All invoices are to be itemized by service description and name of Service Provider, time spent, hourly rate and service date. (See Appendix B). In the event that the Provider s accounting system cannot produce an invoice outlining the time and type of service, the invoice should be accompanied by an activity sheet containing the required information, or use the ICBC Standardized invoice. Actual time spent in providing professional services shall be billed. The report contents and related activities should be consistent with the amount billed. Professional time for initial review of file material may be charged on a one time only basis and should not exceed 3/4 of an hour unless otherwise previously agreed upon with the ICBC Rehabilitation Coordinator/R.B.A. A telephone call is billed as actual time spent on the phone. A message left with an answering machine/voice mail is considered a successful phone call. Long distance charges on calls, which are completed, may be billed as incurred. A copy of the telephone account is required for payment. The following activities are considered costs of doing business and/or overhead costs and are to be reflected in the hourly rate but not billed as additional expenses: Clerical Postage for report transmittal to ICBC Duplication costs for report attachments Supervisory/consultation conference for case discussion Supervision, or staffing Cell phone charges 15

18 billing & accounts Any disbursements agreed upon by ICBC and the Service Provider must be submitted in original form Report and correspondence preparations to be billed by actual time spent. As a general guideline, up to 2.0 hours for initial assessment and.75 professional hours for a progress report is acceptable. Exceptions for unusual activity or a particular complex case may be discussed with the Rehabilitation Coordinator/ Rehabilitation Benefits Administrator. Billings for case consultation or telephone calls must include the names of parties involved and actual time spent. Travel time, physician consultation, facility consultation, labour market surveys, job development activities, and the like that benefit more than one client should be pro-rated. Where applicable, half the professional hourly rate should be charged for travel time. Mileage will only be reimbursed for professional travel at the current rate of.47/km (as of June 1, 2008). Alternatively, an agreement may be reached on a travel expense allowance, based on additional travel costs in servicing rural clients. These cases would have to be pre-authorized by the Rehabilitation Coordinator/R.B.A The Service Provider must advise the Rehabilitation Coordinator/ Rehabilitation Benefits Administrator of a No Show or cancelled appointment. Payment of no show cancellation is normally on a one time only basis. Invoices are to be submitted no more than once monthly. ICBC will pay a satisfactory invoice within 30 days of receipt of that invoice. While health care services are generally not taxable, tax should be included as applicable. 13. Any request for an increase in hourly rate being charged or notice of proposed rate increase needs to be submitted to the local ICBC Manager, Rehabilitation Services for approval. 16

19 supplier system approval for rehabilitation service providers ICBC supplier system ICBC s supplier system was established to: Provide timely and efficient payment to approved suppliers every two weeks. Track payments to satisfy reporting requirements. Issuance of account numbers Account numbers form an integral part of the ICBC supplier system. These numbers are necessary to generate internal reports and track supplier utilization. Consequently, suppliers will need to apply for and obtain numbers for the work they desire to perform. Rehabilitation Service Providers must obtain a supplier account number from the Corporation before they may perform any work for the Corporation. A company can apply for an account number by submitting ICBC form, CL174G, New/Change BI Service Provider Supplier Application, available from any Rehabilitation office. The Rehabilitation Department will notify the applicant of its decision in writing, and if accepted, the company will then receive a supplier account number. The issuance of an account number in no way guarantees that any work will be forthcoming from the Rehabilitation Department, and does not constitute or create a contract or obligation requiring the Rehabilitation Department to provide work or referrals. Account number suspension Any account number, which is inactive for 12 consecutive months, is automatically suspended. After it has been suspended, a new application must be submitted and approved before the number will be reactivated. 17

20 supplier system approval for rehabilitation service providers Service Providers must keep their licences, insurance and association memberships current and in good standing. Failure to do so may result in suspension or termination of their account and/or a request for return of all outstanding referrals. Termination of Service Provider by employer Both the approved Service Provider and the employer must immediately notify ICBC if the Service Provider is terminated by the company. Termination notice must be sent, in writing to the local Manager, Rehabilitation Services. Termination of services to ICBC Rehabilitation Department Both the approved Service Provider and their employer must immediately notify the Rehabilitation Department if they no longer wish to provide their services. A termination of services notice must be sent, in writing, to the local Manager, Rehabilitation Services. 18

21 closure File retention ICBC requires Service Providers to keep all notes, files, reports, information and videotapes for a period of seven years from the date of the Service Provider s closing report. However, if the Service Provider s own association requires a retention period longer than seven years, the association s requirements must be followed. File storage All notes, files, reports, information, computer file data, and videotapes must be stored in a secure environment to ensure confidentiality. These items must be stored in a locked cabinet or other designated area which can be locked. Computers must be password protected. In addition, a Service Provider should contact their professional association (if applicable) and abide by the standards and regulations pertaining to records. File destruction All information must be destroyed so that it cannot be used by any other party for any purpose. This information is confidential, and accordingly, the following safeguards must be followed: a. Notes, files, reports and information: All paper documentation must be fully shredded. Paper shredding must be conducted by a bonded, confidential destruction service, or arrangements can be made to use ICBC shredding machines. b. Information stored on computer: When computer equipment is disposed of, steps must be taken to ensure all information contained on the hard drive, all computer disks, and any other memory systems are rendered 19

22 closure irretrievable. Simply deleting or erasing is not sufficient. Please contact ICBC s Senior Corporate Information Analyst, Data Management Department, at for proper destruction guidelines. c. Audio Visual Materials: (i.e. videotapes, cd s, dvd s, etc.) It is mandatory that all audio visual material be destroyed. Erasing data is not sufficient. Business changes If a Service Provider s company goes out of business, changes ownership, or is terminated, contact Manager, Rehabilitation Operations, in writing. 20

23 service provider evaluations When services are no longer required or have come to a conclusion, the Rehabilitation Coordinator or Rehabilitation Benefits Administrator may request a closure report, depending on their needs. For ICBC purposes, they are also required to complete an evaluation of the services performed by each Service Provider. (See Appendix D). 21

24 Appendix A rehabilitation progress report (sample format) TO: ICBC Rehabilitation Coordinator/R.B.A. RE: Client s Name: Claim Number: Relates to Plan approved on: Program Evaluation Summary: / / DAY MONTH YEAR Goals/Objectives Methods Timeframes Person Responsible Comments: Recommendations: 22

25 Appendix A rehabilitation progress report (sample format) Original Plan Time Frame Valid Yes No (If no, please comment below) New Plan Required? Yes No Next Review Date: (if applicable) / / DAY MONTH YEAR Additional Comment/Summary of Progress: Signature: Name: Qualifications: Date: / / DAY MONTH YEAR For ICBC Use Only: Date Report Received: Approved By Name: Further Reporting Requirements: Signature: Date: / / DAY MONTH YEAR 23

26 Appendix B Invoice (Sample Format) Health Service Provider Invoice ACCOUNT NUMBER A SUPPLIER NAME HST REGISTRANT NUMBER INVOICE NUMBER INVOICE DATE (ddmmmyy) SUPPLIER CONTACT SUPPLIER PHONE NUMBER ICBC CLAIM NUMBER CLIENT FIRST NAME CLIENT LAST NAME DATE OF MVA (ddmmmyy) CLIENT PERSONAL HEALTH NUMBER (PHN) ICBC CONTACT ICBC ADDRESS CITY POSTAL CODE Time Charges (e.g. therapy, consultations, assessments, reports, travel) SERVICE SERVICE HOURS/ DATE SERVICE DESCRIPTION & NAME OF THERAPIST CODE SESSIONS RATE AMOUNT (ddmmmyy) Sub Total HST Expenses and Disbursements (e.g. course fees, memberships, taxi, parking, mileage, medical supplies, prescriptions) SERVICE DATE DESCRIPTION CODE QUANTITY RATE AMOUNT (ddmmmyy) Sub Total Invoice to be completed by provider for all medical-rehab services and supplies outside of MSP. Invoice must be reconciled with pre-approved treatment or rehabilitation plan. CL392 (072010) Invoice Total HST Prior Amount Billed to Date Total Billed $ $ $ 24

27 Appendix C CL174G New/Change BI Service Provider Supplier Application New/Change BI Service Provider Supplier Application New Change Previous Account Number Address Change Name Change Other (IF APPLICABLE) LEGAL NAME OF BUSINESS AND ADDRESS INCLUDING POSTAL CODE POSTAL CODE TELEPHONE NUMBER FAX NUMBER DOING BUSINESS AS (NAME) BUSINESS ADDRESS INCLUDING POSTAL CODE (INCLUDE MAILING ADDRESS ) POSTAL CODE TELEPHONE NUMBER FAX NUMBER HST REGISTRATION NUMBER Principal type of business: (check one) Occupational Therapy Vocational Rehabilitation Speech & Language Life Skills Psychologist/Counsellor Home Support Physiotherapists Medical Supplier Chiropractor Registered Massage Therapist Other: (specify) For new firms: Municipal or City Business Licence (attach copy) WCB Coverage (attach verification) Malpractice Insurance (attach proof) Liability Insurance (attach proof) For each professional: Member of Professional Associations, BCSOT, BCCA, PABC (attach copy) Resume of Education & Work History (attach copy) Provincial College Registration (attach copy) Valid B.C. Driver s Licence (attach copy) Copies of all requested documents must be attached to this form prior to processing. PRINT NAME OF SIGNING OFFICER JOB TITLE SIGNATURE OF SIGNING OFFICER DATE To be completed by ICBC Head Office ONLY All documents attached SIGNATURE POSITION DATE TX Code: ADD A CHANGE C SUSPEND S CL174G (072010) New/Change BI Service Provider Supplier Application 25

28 Appendix D Service Provider Evaluation Form (Sample Format) 26

29 Appendix D Service Provider Evaluation Form (Sample Format) 27

30 notes

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32 GEN252B (072010)