RULE

DESCRIPTION

001

Unless timely steps are taken (at least two hours) to cancel an appointment for a consultation the relevant consultation fee shall be payable by the employee.

003

Newly hospitalised patients willbe allowed up 20 sessions without pre-authorisation. If further treatment is necessary after a series of 20 treatment sessions for the same condition, the treating medical practitioner must submit a pre-authorisation request with a treatment plan to the Compensation Fund for authorisation. Hospitalised patients admitted to ICU and High Care following an emergency will not require authorisation for rehabilitation services. Referral letter from the Medical Doctor with the initial treatment plan and progress report should be submitted with the invoice. Notification of admission to these units must be sent to the Fund by the admitting hospital within 72 hours of such admission with the injured employee's ID copy and WCL4 documents attached. All the cases are subject to case management.

004

AM and PM treatment sessions, applicable only to hospitalised patients, should be specified and medically motivated for on the Annexure F (Motivation for BO Physiotherapy)

005

Out-Patients: In cases of out-patients, all treatment sessions will need pre-authorisation. All requests for pre-authorisation must be based on clinical need, best practice and be in the best interest of the patient. The physiotherapist must submit a referral with motivation from the treating doctor and a treatment plan. The first consultation can be done before pre-authorisation to allow the physiotherapist to provide a treatment plan to the fund for preauthorisation. Practitioners will be allowed up to ten (10) treatment sessions to continue with treatment after submitting their request while awaiting response from the Fund. The physiotherapist must submit monthly progress report. Modifier 0015 must be quoted.

006

"After hour treatment" shall mean all physiotherapy performed where emergency treatment and/or essential continuation of care is required after working hours, before 07:00 and after 17:00 on weekdays, and any treatment over a weekend or public holiday. In cases where the physiotherapist's scheduled working hours extend after 17:00 and before 07:00 during the week or weekend, the above rule shall not apply and the treatment fee shall be that of the normal listed tariff. The fee for all treatment under this rule shall be the total fee for the treatment plus 50 percent. Modifier 0006 must then be quoted after the appropriate tariff code to indicate that this rule is applicable. Where emergency treatment is provided:

007

The physiotherapist shall submit his / her account for treatment directly to the Fund using available electronic means.

008

When an employee is referred for physiotherapy treatment after a surgical procedure, a new treatment plan needs to be provided to the Fund.

009

When more than one condition requires treatment and each of these conditions necessitates an individual treatment, they shall be charged as individual treatments. Full details of the nature of the treatments and the diagnosis or diagnostic codes shall be stated.

Modifier 0009 must be quoted.

010

When the treatment times of two completely separate and different conditions overlap, the fee shall be the full fee for one condition and 50% of the fee for the second condition. Both conditions must be specified.

Modifier 0010 must then be quoted after the appropriate code number to indicate that this rule is applicable.

011

Cost of material does not include consumables (e.g. ultrasound gel, massage oil, gloves, alcohol swabs, facial tissues, paper towels and etc.)

012

An invoice for services rendered will be assessed and added without VAT. VAT is then calculated and added to the final payment amount

013

Where the physiotherapist performs treatment away from the treatment rooms, travelling costs being more than 16 kilometres in total to be charged according to the National Treasury regulation.

If more than one employee is attended to during the course of a trip, the full travelling expenses must be pro rata between the relevant employees (the physiotherapist will claim for one trip). A physiotherapist is not entitled to charge any travelling expenses or travelling time to his / her rooms.

Modifier 0013 must be quoted.

014

Physiotherapy services rendered in a nursing home or hospital. Modifier 0014 must be quoted after each tariff code.

015

The services of a physiotherapist shall be approved only on referral from the treating medical practitioner. Where a physiotherapist's letterhead is used as a referral letter, it must bear the medical practitioner's signature, date and stamp. The referral letter for any physiotherapy treatment provided should be submitted to the Compensation Commissioner with the account for such services.

016

Physiotherapists, Occupational Therapist and Chiropractors may not provide simultaneous treatment at the same time on a day, but may treat the same patient. Multidisciplinary treatment goals must be considered and the best placed service provider to achieve the rehabilitation goal must address that specific goal.