General questions
Are WCB payments part of the government’s physician budget?
No, WCB payments are part of an independent budget funded by employer premiums.
Why are WCB fees different from other fees?
WCB services are unique and expedited and physician services require the exchange of additional information. In recognition, higher fees are paid in the interest of caring for injured workers and getting them back to work as quickly as possible.
Why do orthopedic surgeons have a separate agreement?
The WCB and Alberta Orthopedic Society determined there is value in having a separately negotiated contract. Some of the provisions contained within this agreement have helped move toward a better balance between the two.
What is the term of the current agreement?
The term of the current agreement is April 1, 2020 to December 31, 2024.
Provisions of the agreement
What does clause 14.06 “time shall be of the essence” mean?
This is a standard legal clause in many contracts. It means that the specified time and dates in the agreement are important and mandatory.”
Do the same-day reporting rules and incentives apply both in office and hospital settings? Isn’t that requirement easier to meet in some locations than others (e.g., a busy emergency department)?
The same-day and on-time reporting incentives apply to encounters both in and out of office settings for general practitioner (GP) first reports, specialist consultation reports and all follow-up reports.
“Same day report submission” means that the report is received by WCB on the same date as the completed examination (GP or specialist) which includes up to 10:00 a.m. MT the next business day.
“On time” is defined as receipt within three business days from the date the worker saw the physician for GP reports, again up to 10:00 a.m. MT the next business day.
“On time” for all other reports (specialist and follow ups) is defined as receipt within four business days from the date the worker saw the physician, up to 10:00 a.m. MT the next business day.
What incentives are provided for meeting the timelines?
It is in everyone’s interest for the patient to be treated, recover, and return to work as soon as possible. The agreement provides financial incentives that encourage more timely reporting.
There is a sliding scale for reporting the same day, on time and late. The same-day fee is substantially higher fee for same-day reporting and many physicians can adapt their business processes and systems to meet the requirements most of the time.
The on-time fee recognizes that physicians who are extra busy (e.g., in the emergency department) may not be able to meet the “same day” target.
The late fee is applied when a physician is unable to submit the report within the on-time requirement.
Can the family physicians use the SOMB time modifier code CMGP01? WCB visit reports often take as much time to populate and complete as the 15 minute visit.
The CMGP modifier applies to all activities relating to patient care (e.g., reviewing documents before seeing the patient, seeing, and examining the patient, charting, etc.). The modifier cannot be used for completing the WCB report because the WCB fee code is used for this activity.
Is the time of the patient encounter in the emergency department for same-day reporting based on when the patient registers in the ED? ED patients are sometimes registered on one calendar day, but not seen by the physician until the following calendar day. Is it based on the time when the physician sees the patient or when the patient is discharged?
“Same day report submission” means that the report is received by the WCB on the same date as the completed examination (GP or specialist) up to 10:00 a.m. MT the next business day. If the patient registers at 23:30 hours on January 15th in the ED, but was not seen by the physician until 05:00 hours on January 16th, then the WCB report would be due at 10:00 a.m. on January 17th (or next business day if that day falls on a weekend).
“On time” for GP first reports is defined as receipt within three business days from the date of the completed examination up until 10:00 a.m. MT on the fourth business day following the completed examination.
“On time” for all other reports (GP progress report, and specialist consultation and follow up report) is defined as receipt within four business days from the date of the completed examination up until 10:00 a.m. MT on the fifth day following the completed examination.
“Late” is defined as receipt any time after the designated on-time report submissions.
Often when working out of town, I fill out WCB documents at work, but do not submit until my billing staff issues the invoice and then submits. Sometimes this is a week or two later. Does “on time” mean “invoiced and submitted,” or is “saved with all the patient info completed” acceptable?
The time stamp occurs when all documents are submitted to WCB, including the invoice. This is because the WCB has no other way to confirm/audit whether this time is correct and cannot begin the process without the complete set of data.
The following time frames apply:
- “Same day report submission” means that the report is received by WCB on the same date as the completed examination (GP or Specialist) which includes up to 10:00 a.m. MT the next business day.
- “On time” is defined as receipt within three business days from the date the worker saw the physician for GP reports up to 10:00 a.m.MT the next business day.
- “On time” for all other reports (specialist and follow ups) is defined as receipt within four business days from the date the worker saw the physician, up to 10:00 a.m. MT the next business day.
Who pays for completing the extensive forms that the employers need?
When an employer requests a physician to complete extra forms that are not WCB forms, the physician can bill the employer directly.
Can physicians opt out and simply bill a commercial rate for WCB cases?
No. The AMA negotiates with the WCB on behalf of all physicians. This means that all physicians providing services in Alberta are covered under the AMA agreement with WCB, which prescribes fees/rates to be billed. The WCB pays fee-for-service as per the SOMB plus additional WCB fees for reports, expedited services, etc.
When the patient fails to communicate or refuses to agree on the validity of the WCB visit and the visit has to be re-done on the WCB form, can the patient be “extra billed" for the lost revenue?
No. The Workers’ Compensation Act is provincial legislation. Section 86 of the Act states that “no part of the cost of any medical aid provided to or in respect of a worker under this Part is payable by the worker.” This means the physician is not able to bill the patient if the injury is work-related. WCB will pay the physician for the visit as per the SOMB and will also pay for the report.