Untangling WorkSafeBC billing procedures

WorkSafeBC provides a medical insurance structure parallel to MSP that pays physicians for their treatment through the MSP billings structure when WorkSafeBC is indicated as the insurer on a claim. All patients’ health care needs related to a WorkSafeBC claim must be directed to WorkSafeBC, not to MSP. Billing through WorkSafeBC, when applicable, provides access to unique funding opportunities and ensures that the public health care system does not foot the bill for services that are covered elsewhere.

All visits to physicians must be billed, regardless of the source of the referral or the time from injury or referral. As a specialist in physical medicine and rehabilitation who is not employed by WorkSafeBC, I know too well how difficult this system is to navigate and how poor most physicians’ and MOAs’ understanding of the system is. I therefore took it upon myself to conduct an informal investigation by contacting WorkSafeBC along with numerous physicians and their staff to delve deeper into this problem. My research revealed widespread gaps in knowledge, misunderstanding, and incorrect application of procedures. I also canvased a few dozen colleagues in multiple specialties and learned that many have an incorrect understanding of WorkSafeBC practices. I also learned that WorkSafeBC staff may give incorrect advice (e.g., I was told to log in to the WorkSafeBC portal to retrieve a claim number; however, this is not possible, you must call WorkSafeBC to receive this information). I also discovered that some WorkSafeBC case managers failed to review consults that were faxed in and failed to process expedited billing. 

The following is a summary of the most common misperceptions that I discovered, presented as eight sample scenarios.

My patient was injured at work. They had an overuse injury. Their claim has not been accepted yet, but they do have a WorkSafeBC claim number. Should I bill WorkSafeBC and should I identify the claim to the referred physicians?
Once a claim is initiated, visits should be billed to WorkSafeBC. The date of injury and the claim number should be included on the referral form to indicate that WorkSafeBC is responsible for the billing.

My patient needs to see a specialist for their wrist injury. The wait time to get in to see a specialist in my community is 6 months. Should I contact WorkSafeBC to expedite the referral?
No. If the patient has a claim number you may request an expedited referral to a specialist without contacting WorkSafeBC. The specialist has 15 business days to see the patient and return the consult. However, based on feedback I received, this may result in the specialist not being paid. Faxing the referral to WorkSafeBC may ensure a proper referral is received and triaged.

I am a specialist, and my patient was not expedited to me. There was a cursory mention of a work-related injury on the referral. I have no billing information. Should I just bill MSP?
No. The Physician Master Agreement states that all WorkSafeBC patients must be billed through WorkSafeBC even if not expedited at the MSP rates but through their WorkSafeBC claim number. 

I received a referral that my MOA flagged as WorkSafeBC related. There was no claim information with the referral. Can I choose to expedite?
Yes, you may call WorkSafeBC and obtain the claim information, or call the referring office or patient and choose to expedite. Notifying WorkSafeBC will help to ensure that payment is made. Otherwise, it is prudent to refrain from billing expedited consults until 3 days after you send in the consult, according to WorkSafeBC staff.

My patient has a spinal cord injury from 15 years ago. They need a referral to a urologist, physiatrist, and respirologist. Are these WorkSafeBC concerns, considering that the injury happened many years ago?
Yes. If a patient’s medical complications are the result of a workplace trauma, the referral should include the claim information. The receiving physician must bill WorkSafeBC, not MSP.

My bill to WorkSafeBC was rejected. Will MSP automatically pay the bill instead, as it does for ICBC billings?
No. WorkSafeBC does not default to MSP. You must contact WorkSafeBC to correct the bill. I also learned that many physicians do not know that they must change the insurer from MSP to ICBC on their billing screen or indicate to their billing agent that the insurer is ICBC when seeing ICBC patients. ICBC automatically pays the bill or turns it over to MSP if a claim is not allowed.

Can I refuse to take referrals from WorkSafeBC?
No, a physician cannot refuse a referral based on the patient’s insurer according to the Physician Master Agreement.

I billed a patient under MSP and later learned that the issue related to a WorkSafeBC claim. Should I go back, debit the MSP bill, and rebill WorkSafeBC?
Believe it or not, yes you should. I was given this information by a senior WorkSafeBC billing specialist. I have yet to figure out how to do this or understand why it is my responsibility.

The WorkSafeBC billing process is not yet where it needs to be. It may improve if patients and physicians are educated to clearly identify the WorkSafeBC claim number and date of injury on a referral, and if patients understand that they must always show this information when visiting a physician about a WorkSafeBC-related issue. WorkSafeBC could help to simplify the process by providing a cover letter for all physicians to include with their referral.

Currently the responsibility has been put on physicians and their staff to spend a great deal of administrative time solving WorkSafeBC billing challenges. Calling patients, WorkSafeBC, and referring offices to obtain information, and fixing rejected billing is time consuming. However, a large amount of public funding is being used inappropriately on WorkSafeBC patients. If WorkSafeBC is copied on all medical consults, that should facilitate rapid treatment and quicker rehabilitation and, ideally, faster returns to work. It will increase WorkSafeBC physician payouts, but faster implementation of medical plans should save money.  

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This article has been reviewed by the BCMJ Editorial Board and is provided for information only; it is the opinion of the author and does not reflect the policy or opinion of Doctors of BC.

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Dr Winston is a specialist in physical medicine and rehabilitation based in Victoria. His practice encompasses patients with neurological and musculoskeletal conditions. Dr Winston is not employed by WorkSafeBC. He is open to feedback or corrections from WorkSafeBC regarding his interpretation of the procedures.