July 1: WCB same day/on time report payments increase

June 9, 2015

Have WCB patients? July 1 is an important day!

Reducing turnaround times with financial incentives for same day and on time reports and fee reductions for late reports

July 1 marks the beginning of the second phase of financial incentives pertaining to same day and on time report submissions to the Workers’ Compensation Board, per the recently finalized WCB-AMA Physician Services Compensation Agreement.

In addition to recognizing the reporting requirements and other unique circumstances that physicians experience when providing health services to WCB patients, the agreement focuses on the importance of timely reporting and the many ways in which patients benefit from this, including prompt receipt of the WCB benefits they’re entitled to, timely return-to-work planning and ultimately, a speedier recovery and resumption of normal, productive lives.

The WCB-AMA agreement compensates physicians accordingly for the timely submission of reports, with gradually increasing financial incentives applied to same day and on time report submissions (see Definitions, below) and a series of phased-in fee reductions for late report submissions.

WCB information:
WCB fee schedule: Effective July 1, 2015 - Alberta physicians (pdf, 65KB)
WCB Physician Services: new fee schedule, physician forms and guides

30% fee increase in same day WCB reports by April 1, 2017

In April, the Alberta Medical Association (AMA) and the Workers’ Compensation Board (WCB) signed the WCB-AMA Physician Services Compensation Agreement for the term October 1, 2014 to March 31, 2019.

Financial incentives (retroactive to April 1, 2014) will continue in phases – July 1, 2015; April 1 and July 1, 2016; and April 1, 2017 – over the course of the agreement’s term, building up to a 30% fee increase for same day reports and a nearly 20% increase for on time reports (see Definitions, below).

Late report fee reduction

As a disincentive to late reporting (i.e., reports received after the on time period), the agreement includes a late report fee reduction, beginning as a fairly small decrease on July 1, 2015 (current late fee of $62.13 will decrease to $57.32), followed by an April 1, 2016 decrease to 90% of the current on time fee and a July 1, 2016 decrease to 75% of the current on time fee, with no further adjustment on April 1, 2017. (See Appendix “C,” below)

Same day and on time report submissions: Extensions

Considering the challenges emergency and rural physicians often face when attempting to file timely WCB reports, the new agreement includes extensions of the previous timeframes associated with same day and on time report submissions, per the following definitions:

Definitions

Same day report (GP or Specialist) submission
The report is received by WCB on the same day as the completed examination, including up to 10:00 on the following business day.

Note: “Business Day” is defined as Monday through Friday from 00:00:00 to 23:59:59 MST each day, excluding the Employment Standards Code of Alberta designated holidays: New Year’s Day, Alberta Family Day, Good Friday, Victoria Monday, Canada Day, Labour Day, Thanksgiving Day, Remembrance Day, Christmas Day, Boxing Day and August 1 civic holiday).
“Examination Date” = day 0

Scenario A: Patient registers at 11:00 Monday. Physician sees patient and completes examination at 1300 Monday. For same day status, WCB needs to receive the report by 10:00 Tuesday.
Scenario B: Patient registers at 23:30 Friday. Physician sees patient and completes the examination at 02:00 Saturday. For same day status, WCB needs to receive the report by 10:00 Monday.

On time report submission

GP First Report – The report is received by the WCB within three (3) business days from the date of the completed examination, including up to 10:00 on the fourth (4) business day.

GP Progress Report – The report is received by the WCB within four (4) business days from the date of the completed examination, including up to 10:00 on the fifth (5) business day.

Specialist Consultation Report/Specialist Follow-up Report – The report is received by the WCB within four (4) business days from the date of the completed examination, including up to 10:00 on the fifth (5) business day.

Scenario: Patient registers at 19:00 Tuesday. Specialist sees patient and completes the examination at 22:00 Tuesday. In order for this Specialist Consultation/Specialist Follow-up report to be classified as an on time report submission, WCB must receive the report by 10:00 the following Tuesday.

Late report submission
A report is considered late if it is received by WCB after the on time reporting schedule applicable to the type of report: GP First Report, GP Progress Report or Specialist Consultation/Follow-up Report).

Receiving vs. Submitting

It’s important to note that a “same day or on time report submission” refers to the time when WCB receives a report and does not refer to the time the report is submitted.

Before July 1: Modify your reporting process

Avoid Batching...

Batching reports (which often delays reports) will prevent you from optimizing the WCB’s new same day and on time reporting incentives. It’s recommended that in order to capitalize on these reporting incentives (and to avoid late report fee reductions), you work with your billing software vendor and/or submitter to update and revise your current reporting process, preferably before July 1.

Batching reports (which often delays reports) will prevent you from optimizing the WCB’s new same day and on time reporting incentives. It’s recommended that in order to capitalize on these reporting incentives (and to avoid late report fee reductions), you work with your billing software vendor and/or submitter to update and revise your current reporting process, preferably before July 1.

The WCB’s Electronic Injury Reporting (EIR) system remains an efficient and convenient way to submit reports. As of last review, 49% of reports were submitted by physicians and/or their staff versus 51% submitted online by a vendor.

Appendix "C"

Reporting Funding Schedule

For more information, contact:
Didi Wimmer-Frank
Director, Contract Negotiations
Alberta Medical Association
T 780.482.0698 │ F 780.482.5445
didi.wimmer-frank@albertadoctors.org