Direct Billing of WSIB Patients
You are a physiotherapist who owns a private practice and provides physiotherapy services to patients who were injured at work and have approved WSIB claims. When you treat WSIB patients you bill them directly at your regular rate. You provide the patients with receipts which they submit for reimbursement. You have received conflicting information about whether this practice contravenes the Workplace Safety and Insurance Act (WSIA). Until now, you have assumed the practice is acceptable since WSIB has reimbursed the patients to the maximum rate of $24.00/visit and you are aware that many practitioners working in private practice are doing the same thing. What should you do to clarify whether or not the practice is appropriate?
Response
In formulating an analysis of this scenario, the College spoke with representatives from the Health Services Branch of the WSIB. As registrants of the College, you have professional obligations to the College and as providers of physiotherapy services to injured workers in Ontario, you have obligations to the WSIB.
The College and the WSIB worked collaboratively to develop the following analysis. It incorporates feedback and clarification from the WSIB on what is meant by "contract" and an interpretation by both the WSIB and the College of how registrants must bill for physiotherapy services provided to WSIB patients according to the WSIA.
When is there a contract with the WSIB?
Physiotherapy services that are not provided in a WSIB designated Community Clinic are considered regular stream physiotherapy and WSIB does not have, nor do they require, a contract with providers of regular stream physiotherapy services.
What are a physiotherapist's contractual obligations?
When a physiotherapist provides physiotherapy services to a patient, the physiotherapist is obligated to provide these services according to the contractual obligations between the provider and the payer. For example, a physiotherapist providing services to an MVA patient has obligations around billing. If a patient has extended health care benefits, those benefits are first exhausted before motor vehicle insurance funding can be accessed. In the case of OHIP, a physiotherapist is still required to obtain a referral for treatment from a physician and can only bill OHIP for treatment and not for assessment or re-assessment. The requirements for the provision of physiotherapy services for work injured patients in Ontario are articulated in the WSIA. The Act states that physiotherapists cannot bill the patients directly. Physiotherapists must bill the WSIB.
Recommendations
The College recommends that registrants who are treating WSIB patients review those sections of the WSIA that apply to them. Practitioners must comply with the legislation as it is currently written if they choose to treat WSIB patients. This applies not only to a WSIB scenario. Within any system where physiotherapy services are provided, registrants are obligated to understand and comply with legislation or policies that define and describe their activities.
