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Department of Education Division of Vocational Rehabilitation Bureau of Rehabilitation & Reemployment Services

Department of Education Division of Vocational Rehabilitation Bureau of Rehabilitation & Reemployment Services. Carrier Training Module. CARRIER TRAINING MODULE Contents of Training Module – Page 1of 3. Purpose Reemployment Services Audits Statutory Authority Statutory Intent Audit Items

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Department of Education Division of Vocational Rehabilitation Bureau of Rehabilitation & Reemployment Services

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  1. Department of EducationDivision of Vocational RehabilitationBureau of Rehabilitation & Reemployment Services Carrier Training Module

  2. CARRIER TRAINING MODULEContents of Training Module – Page 1of 3 • Purpose • Reemployment Services Audits • Statutory Authority • Statutory Intent • Audit Items • Reemployment Status Review (DWC-22) • Voluntarily Provided Services • Reemployment Services Billing Form (DWC-21) • Referrals to the Department • Notification of Department Services • Audit Checklist

  3. CARRIER TRAINING MODULEContents of Training Module – Page 2 of 3 • Qualified Rehabilitation Provider Requirements • Statutory and Rule Citations • BRRS Roles Regarding QRPs • Non-Qualified Rehabilitation Providers • Allowable QRP Services • Use of Interns • Non-QRPs Working Under a Listed QRP’s Number • Use of Interpreters • QRP Status Revocation • Advertising for QRPs

  4. CARRIER TRAINING MODULEContents of Training Module – Page 3 of 3 • Qualified Rehabilitation Provider Requirements (Cont.) • Managed Care Referrals • AHCA Internal/External Case Management Requirements • BRRS Case Management • Licensed Practical Nurses • Meeting QRP Workshop Requirements • Automated E-mails • Educational and Technical Assistance • Contacts

  5. CARRIER TRAINING MODULE REEMPLOYMENT SERVICES AUDITS

  6. CARRIER TRAINING MODULEPurpose The purpose of this training module is to provide the information necessary to ensure that carriers and qualified rehabilitation providers will be in compliance with the provisions of Section 440.491, Florida Statutes, and Rule Chapter 6A-22, Florida Administrative Code.

  7. CARRIER TRAINING MODULEStatutory Authority On an on-going basis, the Bureau audits the performance of all Florida Workers’ Compensation insurance carriers and servicing agents for compliance with the statutory intent and requirements under s. 440.491, Florida Statutes, and Rule 6A-22, Florida Administrative Code.

  8. CARRIER TRAINING MODULEStatutory Intent The statutory intent is defined in subsection 440.491 (2), Florida Statutes, as “…to implement a systematic review by carriers of the factors that are predictive of longer-term disability and to encourage the provision of medical care coordination and reemployment services that are necessary to assist the employee in returning to work as soon as is medically feasible.”

  9. CARRIER TRAINING MODULEStatutory Intent: Three Main Points (1) Assist injured workers with returning to work as soon as medically feasible; (2) Perform a systematic review of factors that are predictive of longer-term disability; and, (3) Encourage the provision of Medical Care Coordination and Reemployment Services.

  10. CARRIER TRAINING MODULEAudit Items Carrier files are audited to determine compliance with statutory and rules requirements in the following areas: Reemployment Status Reviews (DWC-22’s) Voluntary services and use of Qualified Rehabilitation Providers (DWC-21’s) Referrals of IE’s to the Department Notification of Department Services (DWC-23)

  11. CARRIER TRAINING MODULEReemployment Status Reviews (DWC-22) The Reemployment Status Review, reported by the carrier to the Department on Form DWC-22, determines whether the worker is likely to return to work.

  12. CARRIER TRAINING MODULEReemployment Status Reviews (DWC-22) When are Reemployment Status Reviews performed? • 60 days after the date of accident when the injured employee • remains unemployed, and • is receiving Temporary Total Disability (TTD), Temporary Partial Disability (TPD), or Wage Loss benefits, and • is not receiving Medical Care Coordination (MCC) or Reemployment Services (RES) as defined in s. 440.491, Florida Statutes. • Repeated every 90 days as specified when above criteria are met.

  13. CARRIER TRAINING MODULEReemployment Status Reviews (DWC-22) Important Note: Services provided under a Managed Care Contract pursuant to Section 440.134, Florida Statutes, and Rule Chapter 59A-23.002(7), Florida Administrative Code, do NOT exempt the carrier from its responsibilities under Section 440.491, Florida Statutes, including the completion and filing of the Reemployment Status Review.

  14. CARRIER TRAINING MODULEReemployment Status Reviews (DWC-22) Common DWC-22 Errors Block #2 - Invalid SSN Block #3 - No Date of Accident Block #5 - No Date of Review Block #7 - No Carrier/TPA Address Block #8 - No Carrier Code Block #9 - No Third Party Administrator (TPA) Code Block #10 - Incomplete and/or No Explanation ***Illegible ***Incorrect Form (use form dated 5/5/04) ***No Carrier Date Stamp

  15. Reemployment Status Review (Form DWC-22) Date Stamp #2 #3 #5 #8 #7 #9 #10 Use Form Dated 05/05/04

  16. CARRIER TRAINING MODULEReemployment Status Review (Electronic DWC-22) • Rule 6A-22.003 (2) , F.A.C., which requires electronic submission of the form DWC-22, was revised on May 7, 2009. • Mandatory electronic submission of form DWC-22 becomes effective November 7, 2010.

  17. CARRIER TRAINING MODULEReemployment Status Review (Electronic DWC-22) • The carrier shall complete an electronic Form DWC-22 within 15 days of the reporting requirement deadlines set forth in Section 440.491(3)(a), F.S. (Refer to slide 9). • The carrier shall retain a copy in the carrier’s file. • Within 15 days of completion, the carrier shall submit the electronic form DWC-22 to the Department’s website at www.rehabworks.org/brrs or http://wc-returntowork-vr.doe.st.fl.us/rehabforms .

  18. CARRIER TRAINING MODULEReemployment Status Review (Electronic DWC-22) • The electronic form DWC-22 shall comply with the File Layout for Electronic Submission. (See the “Electronic Forms Reporting System User’s Manual” on the BRRS website.) • BRRS designed the electronic system with built-in edits to assist carriers or TPAs determine if the information entered on a DWC-22 form would be considered valid by the BRRS before the form is submitted to the Department. The system will not accept invalid data entries.

  19. CARRIER TRAINING MODULEReemployment Status Review (Electronic DWC-22) Access to the Electronic Forms Reporting System • The BRRS must grant system access to a user before the system can be used for electronic submission of form DWC-22. • To gain access to the system, a user must go to the “Electronic Forms Reporting System User’s Manual” on the BRRS website to print out a User Request Form. Complete the form and submit it to the BRRS. The BRRS will create a user account and assign a user ID and password.

  20. CARRIER TRAINING MODULEReemployment Status Review (Electronic DWC-22) Restricted Use Policy • The design of the Electronic Forms Reporting System limits form access to only those authorized users. • Carriers and TPAs will only be able to view those forms that list their Division of Workers’ Compensation assigned 3 or 4-digit carrier or TPA code under the field labeled “Workers Comp ID.”

  21. CARRIER TRAINING MODULEVoluntarily Provided Services • Voluntary services include the following services: • Medical Care Coordination (MCC) • Reemployment Assessments (REA) • Reemployment Services (RES) • For MCC, REA, and RES, carriers must use Qualified Rehabilitation Providers (QRPs) listed in the directory. • For RES, carriers must prepare a reemployment plan that is approved by both the carrier and the injured employee.

  22. CARRIER TRAINING MODULEReemployment Services Billing Form (DWC-21) Reporting of Voluntary Services • Voluntary services are reported on Form DWC-21, dated 05/05/2004. • Form DWC-21 should be properly completed and submitted to the Department. • Form DWC-21 should be accompanied by a report in the carrier’s file.

  23. CARRIER TRAINING MODULEReemployment Services Billing Form (DWC-21) Common DWC-21 Errors Block #2 - Invalid SSN Block #3 - No Date of Accident Block #4 - No Date of Referral Block #6 - No Carrier/TPA Address or Carrier/TPA Code Block #10 - No Provider Name/Provider Number Block #14 - No Dates of Service Block #15 - Invalid Service Codes (MCC, RES, & REA only) Block #20 - No Date Received Block #21 - No Date Reimbursed Block #23 - No Total Amount Reimbursed ***Illegible ***Incorrect form (use form dated 5/5/04) ***No Carrier Date Stamp

  24. Reemployment Services Billing Form (DWC-21) Date Stamp #2 #3 #4 #7 #6 #10 #10 #14 #15 #20 #21 #23 Use Form Dated 05/05/04

  25. CARRIER TRAINING MODULEReemployment Services Billing Form (Electronic DWC-21) • Rule 6A-22.003 (2) , F.A.C., which requires electronic submission of the form DWC-21, was revised on May 7, 2009. • Mandatory electronic submission of form DWC-21 becomes effective November 7, 2010.

  26. CARRIER TRAINING MODULEReemployment Services Billing Form (Electronic DWC-21) • A qualified rehabilitation provider (QRP) providing either employer or carrier sponsored reemployment services, reemployment assessments, or medical care coordination shall report on electronic form DWC-21 only those services provided by or through the authorized QRP. • The QRP shall submit a properly completed electronic form DWC-21 listing the specific service(s) provided, utilizing only valid service codes and descriptors for those direct services rendered to the injured employee.

  27. CARRIER TRAINING MODULEReemployment Services Billing Form (Electronic DWC-21) Initial, Interim, and Final Form Submissions • The initial electronic form DWC-21 shall be submitted to the Department within thirty (30) days of the contract approval date for Department sponsored services or to the employer or carrier within thirty (30) days of the date of the referral for employer or carrier sponsored services. • An interim electronic form DWC-21 shall be submitted at thirty (30) day intervals thereafter during which the authorized services are provided. The DWC-21 should not be filed if services are not provided within any thirty (30) day period.

  28. CARRIER TRAINING MODULEReemployment Services Billing Form (Electronic DWC-21) Initial, Interim, and Final Form Submissions (cont.) • A final electronic form DWC-21 shall be submitted within thirty (30) days of the date of the last service provided. • Close a file and submit a final electronic form DWC-21 when attorney involvement interferes with the provision of direct services.

  29. CARRIER TRAINING MODULEReemployment Services Billing Form (Electronic DWC-21) The Employer or Carrier Shall: • Ensure that the information required in this rule is provided on the DWC-21 prior to payment and filing of the electronic DWC-21 with the Department; and • Approve or deny the provision of services recommended as part of an individualized written rehabilitation program within 15 calendar days of receipt of the same; and • Pay or deny DWC-21 bills within 45 calendar days after receipt of a bill for services provided to an injured employee; and • Complete blocks 20, 21 and 23 on every electronic DWC-21 filed with the Department.

  30. CARRIER TRAINING MODULEReemployment Services Billing Form (Electronic DWC-21) The Employer or Carrier Shall (Cont.): • File the electronic DWC-21 with the Department of Education on the Department’s website at www.rehabworks.org/brrs or http://wc-returntowork-vr.doe.st.fl.us/rehabforms within thirty (30) days after the full or partial payment of form DWC-21. • The electronic DWC-21 shall comply with the File Layout for Electronic Submission, Revision C Record Length: 1200 Header Record Layout for DWC-21 as incorporated by reference in Rule 6A-22.011, F.A.C. (See the “Electronic Forms Reporting System User’s Manual” on the BRRS website .) • BRRS designed the electronic system with built-in edits to assist carriers or TPAs determine if the information entered on a DWC-22 form would be considered valid by the BRRS before the form is submitted to the Department. The system will not accept invalid data entries.

  31. CARRIER TRAINING MODULEReferrals to the Department • Injured employees may be referred to the Department at any time using Form DWC-23 (Request for Screening). • Referrals to the Department are required when • The QRP determines training and education is necessary, and • 180 days after the referral date for RES or when the injured worker receives $2,500.00 in RES. • It is important that the carrier sign the DWC-23 before submitting it to the Department.

  32. Request for Screening Form (DWC-23)

  33. CARRIER TRAINING MODULENotification of Department Services The carrier is required to notify the injured employee in writing of the availability of Department services 180 days post injury if the IE is unemployed and receiving compensation.

  34. CARRIER TRAINING MODULEAudit Checklist The BRRS Audit Team examines case files to ascertain compliance with the statute and rules by asking the following questions: • What are the dates, type, and amount of indemnity benefits paid? • Is the Injured Employee (IE) working? • Was there a referral for MCC or RES? • What are the dates of service on Form DWC-21? • Is a copy of the correspondence present? • Are Forms DWC-21 present if required? • Are Forms DWC-22 present if required?

  35. CARRIER TRAINING MODULEAudit Checklist (Cont.) • Is Form DWC-23 present if required? • Are accompanying reports to the Electronic DWC-21 present? • Are valid Qualified Rehabilitation Providers used? • Is an Individualized Reemployment Plan present if required? • Are payments timely? • Are Form submissions timely? • Are Form submissions correct?

  36. CARRIER TRAINING MODULE QUALIFIED REHABILITATION PROVIDER (QRP) REQUIREMENTS

  37. CARRIER TRAINING MODULEStatutory and Rule Citations The qualifications and requirements for Qualified Rehabilitation Providers (QRPs) are delineated in the following statute and rule: • Section 440.491(7) (d), Florida Statutes • Rule 6A-22.002, Florida Administrative Code

  38. CARRIER TRAINING MODULEBRRS Roles Regarding QRPs The BRRS is responsible for the following activities: • Approving QRPs who submit proof of meeting minimum requirements established by Rule 6A-22.002, Florida Administrative Code; • Investigating and maintaining a directory listing of QRPs, facilities, and agencies; • Establishing by rule the minimum qualifications and/or credentials to be eligible for listing in the directory;

  39. CARRIER TRAINING MODULEBRRS Roles Regarding QRPs (Cont.) • Monitoring and evaluating each rehabilitation service provider and agency to ensure compliance with minimum qualifications and credentials; • Imposing a biennial application fee of $25 for each listing in the directory; and, • Providing Bureau-sponsored QRP Workshops (face-to-face and web-based).

  40. CARRIER TRAINING MODULENon-Qualified Rehabilitation Providers • Individuals who are not listed in the directory can not provide medical care coordination, reemployment services, reemployment assessments, or vocational evaluations. • Individuals who are not QRPs can not provide expert testimony on rehabilitation issues in Florida.

  41. CARRIER TRAINING MODULEAllowable QRP Services Section 440.491, Florida Statutes, specifies the services that a QRP can provide: • Medical Care Coordination • Reemployment Services • Reemployment Assessments • Vocational Evaluations by a Certified Vocational Evaluator (CVE)

  42. CARRIER TRAINING MODULEUse of Interns • There are currently no provisions that allow for the use of interns. • Former Rule 38F-8.039, Florida Administrative Code, which became effective March 26, 1984, authorized the use of interns. • However, Rule 38F-8.039, Florida Administrative Code, was repealed effective 11/12/95, and the use of interns is no longer allowed.

  43. CARRIER TRAINING MODULENon-QRPs Working Under a Listed QRP’s Number • Individuals who have not met the requirements to become a QRP and have not been assigned a Florida WC Provider Number should not be providing services under any circumstances. • Any use of a non-QRP is in violation of Rule 6A-22, Florida Administrative Code and s. 440.491, Florida Statutes. • A QRP who reports and bills for services conducted by a non-QRP will have his/her QRP status revoked and be reported to the ethics committee of the credentialing board.

  44. CARRIER TRAINING MODULEUse of Interpreters Although services may require the use of an interpreter, “all services provided by a carrier or a rehabilitation company under Section 440.491, Florida Statutes, shall be provided only by an individual who is a qualified rehabilitation provider or a facility that is a qualified rehabilitation provider.”

  45. CARRIER TRAINING MODULEQRP Status Revocation Rule 6A-22.002(4), Florida Administrative Code, allows the Bureau to revoke approval of a qualified rehabilitation provider, company, or facility for a period of six (6) months for one or more of the following reasons: • Revocation of credentials or certification by the applicable certification or credentialing board, • Misrepresentation of credentials or certification, or • Allowing a non-qualified rehabilitation provider to fraudulently report and bill for services using an individual’s, company’s, or facility’s WC Provider Number.

  46. CARRIER TRAINING MODULEAdvertising for QRPs • Advertisements recruiting rehabilitation providers that state “QRP Eligibility Required” are misleading. Individuals who have not been issued a WC Provider Number are ineligible to provide services for injured workers in Florida. • The BRRS will not grant waivers for any reason.

  47. CARRIER TRAINING MODULEManaged Care Referrals • Managed Care case referrals are referred under a Managed Care Arrangement approved by the Agency for Health Care Administration (AHCA). • Cases referred other than those administered by a Managed Care Arrangement come under the purview of reemployment services in accordance with s. 440.491, Florida Statutes.

  48. CARRIER TRAINING MODULEAHCA Internal/External Case Management Requirements • AHCA rules under Chapter 59A-23.002(7), Florida Administrative Code, define “external case management” as face-to-face medical care coordination performed by a QRP pursuant to s.440.491, Florida Statutes. • AHCA rules under Chapter 59A-23.002(10), Florida Administrative Code, do not state that individuals performing “internal case management” have to meet QRP requirements pursuant to s.440.491, Florida Statutes.

  49. CARRIER TRAINING MODULEBRRS Case Management • Case management under the context of medical care coordination or other reemployment services defined in s.440.491, Florida Statutes, and Rule 6A-22, Florida Administrative Code, must be performed by a QRP. • All case management services must be reported and billed using Form DWC-21 (Reemployment Services Billing Form).

  50. CARRIER TRAINING MODULELicensed Practical Nurses • A licensed Practical Nurse does not qualify as a QRP. • Only a nurse licensed in the state of Florida as a registered professional nurse and who provides proof of one of the accepted professional credentials may apply to become a QRP and be listed in the directory.

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