All posts by Chris Semenuk

About Chris Semenuk

Chris graduated from massage therapy school in London, Ontario, in 2000 and has been an RMT since January, 2001. Immediately, Chris gave back to the sport that got him into massage therapy by volunteering with the Western Mustangs Track & Field team, and a few years later becoming part of the Cross Country team too. He was given the role as Head of Massage Therapy, which he holds to this day. In 2015 Chris served as a Lead Medical Practitioner for the Toronto Pan Am Games. Since 2001, Chris has focused on the clinical side of Massage Therapy, and was also a professor from 2001 to 2012. The pinnacle of his education career has been building the Fanshawe College Massage Therapy program in the summers of 2011 & 2012. In addition to supplying sports massage to the Mustangs programs, Chris has been an Assistant Coach since 2011.

Applying HST to Massage Therapy for Automobile Incidents (MVA, MVC, MVI) Health Claims

hst-624x313

It comes up every now and then that a misinformed Auto Insurance Company (Adjustor) will try to not pay the HST (GST for some Provinces) portion of billings made by an HST registered RMT. This causes many headaches for the RMT who is now forced to try and get the Insurance Company to understand that the HST is to be paid over-and-above the Fee approved by the FSCO. Many times an RMT feels they must “factor out” the HST from the amount they were paid by the Auto Insurance Company as an only option when the Adjustor never pays. This is wrong, in so many ways. It must be stopped.

“It’s not in the SABS”

This is a common go-to reason by Adjustors to supply a reason for not applying HST above the FSCO Fee. The Adjustor will hide behind this Ontario Act as a reason for non-payment of the tax. It will be indicated that “the language of the SABS does not allow for HST to be paid beyond the Fee Schedule”, or some form of that wording. They will then inform the RMT that they legally do not need to pay the HST beyond the fee as the Act protects their interest in not paying.

This is not acceptable. They take advantage of an RMT’s lack of knowledge with Acts to manipulate the situation. They force RMTs to back down and think there is no way to fight them on the issue.

The fact is; the Ontario SABS (Statutory Accident Benefits Schedule, under the Insurance Act, R.S.O. 1990, c. I.8) has nothing to do with determining the application of HST, in any way-shape-or-form. Instead the Act is superseded by The Excise Tax Act (R.C.S., 1985, c. E-15.) of Canada, which is what determines the application of GST/HST. It should not be confused with the Income Tax Act (Canada). 2014, c. 7, Sched. 14, s. 1., which does not determine the application of GST/HST. This is mentioned, as the Insurance Act references the Income Tax Act and that Insurance does not pay for it as a separate item for their clients (when claiming income loss).

“But Physiotherapists do not collect it”

Another cop-out statement. Our profession did not determine the application of the tax. It is not something we chose to do over any profession that does not collect it. It is actually a sore spot that we are even expected to collect a “service” tax for a medically recognized intervention. But, until we have 5 Provinces recognizing Massage Therapy as a medical profession, allowing us to even apply for exemption, we are stuck collecting it for the Government.

Another cop-out is when they state that other RMT’s do not charge it, or that you didn’t charge it before. This, again, has been determined by the Excise Tax Act. One who operates a Small Business (like Massage Therapy) is not required to collect the tax until such time that their revenue from sales in 4 consecutive Quarters is $30,000 or more (more on that here). So, not all RMT’s collect it, because it is not a blanket requirement by our profession as a whole, it is a requirement of the Government applied on a case-by-case determination.

Backed up by the FSCO

The Financial Standards Commission of Ontario (FSCO) is a representative of the Ontario Government through the Ministry of Finance, which means they have been granted power to speak for the Ontario Government (http://www.fsco.gov.on.ca/en/About/Pages/default.aspx). They also happen to be the branch of Government that regulates the Auto Insurance Industry.

Their stance has been previously published several times on the matter of HST being applied to Auto Insurance Fee payouts. This has been done through The Professional Services Guideline (Superintendent’s Guideline No. 03/14);

“The applicability of the HST to the services of any health care professionals or health care providers listed in this Guideline falls under the jurisdiction of the Canada Revenue Agency (CRA). If the HST is considered by the CRA to be applicable to any of the services or fees listed in this Guideline, then the HST is payable by an insurer in addition to the fees as set out in this Guideline.”

It has also been specifically published in a Bulletin released by the FSCO, on their website, in regards to the above Fee Guideline:

“Insurers are reminded that in the absence of such wording in the SABS or other such Guidelines (e.g., Minor Injury Guideline), the direction remains the same.

FSCO expects that insurers will apply the HST legislation correctly in accordance with any direction from CRA. The HST is a tax and is not part of the benefit limits set out in the SABS.” https://www.fsco.gov.on.ca/en/auto/autobulletins/2015a/Pages/a-04-15.aspx

It says it right there; they fully “expect” compliance from an Insurance Company to pay the HST on top of any fee’s that are charged to the Company that requires it. No other option.

 

Conclusion

In the application of the tax, it does not matter whether the Insurance company agrees with it, or if it is mentioned in the SABS, or even under the Insurance Act. What matters is that the Canadian Government has determined that services that have not been granted exempt status must add GST (HST in specific Provinces) as a percentage of any fee that is charged.

In short this means: On top of any fee amount that has been determined.

 

 

 

Pre-Written Form Letter:

Dear [insert adjustors name]

Re: Refusal to pay HST in regards to [INSERT FILE/CLAIM NUMBER]

I have received notification from you on [INSERT DATE] that your company, through you, refuses to pay the HST portion in addition to the fees that were invoiced for services rendered to [INSERT PATIENT NAME, FILE/CLAIM NUMBER], following and approved OCF 23 or 18 for whatever reason.

Please be advised that you are required, both by your registering body, the FSCO, and the Canadian Revenue Agency of Canada to pay the HST portion in addition to Fees that are published through the FSCO. Failure to pay the HST (which is calculated by a percentage based on the approved fee, not calculated into it) portion of the invoice (OCF 21) is in violation of the FSCO position, and Excise Tax Act (R.C.S., 1985, c. E-15.) (http://laws-lois.justice.gc.ca/eng/acts/e-15/) that the CRA enforces. This tax is required by the Government of Canada, and not by the massage therapy profession, to be paid. Further; be advised that HST, when required to collect, is applicable above and beyond not just the FSCO Guideline rate, but also any MIG Block Fees that have been published. Relative references regarding such are offered in the following quotes and the websites from which they were obtained:

“Insurers are reminded that in the absence of such wording in the SABS or other such Guidelines (e.g., Minor Injury Guideline), the direction remains the same.

FSCO expects that insurers will apply the HST legislation correctly in accordance with any direction from CRA. The HST is a tax and is not part of the benefit limits set out in the SABS.”

https://www.fsco.gov.on.ca/en/auto/autobulletins/2015a/Pages/a-04-15.aspx

“The RMTAO had contacted the Financial Services Commission of Ontario (FSCO) several months ago to clarify the application of HST on top of the customary fees applied for the services of massage therapy in the Minor Injury Guideline. We recently received a response from FSCO which they also published in a public bulletin.

The FSCO Professional Services Guideline states that “If the HST is considered by the CRA to be applicable to any of the services or fees listed in this Guideline then the HST is payable by an insurer in addition to the fees set out in this Guideline.”
https://secure.rmtao.com/default.asp?id=1151&article=55

“Harmonized Sales Tax (HST) The applicability of the HST to the services of any health care professionals or health care providers listed in this Guideline falls under the jurisdiction of the Canada Revenue Agency (CRA). If the HST is considered by the CRA to be applicable to any of the services or fees listed in this Guideline, then the HST is payable by an insurer in addition to the fees as set out in this Guideline.” https://www.fsco.gov.on.ca/en/auto/autobulletins/2014/Documents/a-08-14-1.pdf

“According to FSCO, the insurer must pay HST in addition to the amounts that are payable under the Statutory Accident Benefits Schedule (SABS) and the MIG. This means that the HST portion of the cost of massage therapy is not counted toward the MIG caps and must be paid in addition to these caps.”  http://www.massagetherapycanada.com/collaboration/hst-and-insurance-reimbursement-in-ontario-2224

In consideration of all the above; I am now restate the need for your company to pay the HST portion of the billing, which has not been delivered. If this is not delivered, or I have not heard from you with intent to deliver, within 15 business days, I will be left no option other than to issue a complaint of non-compliance with the FSCO and the CRA for refusal to pay the HST.

Thank you for your anticipated co-operation in this matter.

Regards,

 

[INSERT YOUR NAME AND REG #. and sign above]

Chris Semenuk

Chris Semenuk

Registered Massage Therapist at Chris Semenuk Massage Therapy - London, Ontario
Chris graduated from massage therapy school in London, Ontario, in 2000 and has been an RMT since January, 2001. Immediately, Chris gave back to the sport that got him into massage therapy by volunteering with the Western Mustangs Track & Field team, and a few years later becoming part of the Cross Country team too. He was given the role as Head of Massage Therapy, which he holds to this day. In 2015 Chris served as a Lead Medical Practitioner for the Toronto Pan Am Games. Since 2001, Chris has focused on the clinical side of Massage Therapy, and was also a professor from 2001 to 2012. The pinnacle of his education career has been building the Fanshawe College Massage Therapy program in the summers of 2011 & 2012.

In addition to supplying sports massage to the Mustangs programs, Chris has been an Assistant Coach since 2011.
Chris Semenuk

Understanding the CEU Cycle and Requirements for Ontario RMTs

Every year around October; RMTs start to stress over their CEUs. The first question always asked is: “Is this the year I am suppose to report?”. There is an easy way to figure this one out.  Your 3 year cycle will always begin on the November 1st following your registration. So IF you were registered on October 31st, 2015 your cycle begins November 1st, 2015. But if you were registered on November 1st, 2015 your cycle begins the next year on November 1st, 2016. The chart for this is located at the following CMTO link.

http://www.cmto.com/registrants/quality-assurance/ceu-cycles-and-due-dates/

The Second question will be “When is the CEU report due?” and/or “Is it due at the end of October? The answer is: The report is due by the first December 31st following the end of your cycle. This gives you 2 months between the end of your cycle and the time it is due; to compile the information that must be handed in.

In other words; you have some time to breathe still, if you started to panic in October about reporting. But if you don’t actually have all your CEUs; you do have to figure out how you will get them done before the day ends on October 31st.

Now online

The CMTO has now made reporting very easy by having an online portal that RMTs can fill in with their CEUs. Not only at the time of reporting, but all throughout your reporting cycle. This allows RMTs a place to also track their CEUs and ensure that they have what is needed before the end of the cycle rolls around.

To access this you must login to your CMTO account first. All CEU reports are kept confidential with your member account.

Why can I not Submit?

What many RMTs have noticed is that when they have reached their CEU total and want to now submit them officially, they can’t. Don’t fret about this. Your cycle does not end until Midnight on October 31st of your reporting year. Your ability to submit does not become active until, November 1st of your reporting year. This means that until November 1st officially arrives; you can still collect, and report, CEUs to the College. So if you already have your 30 CEUs logged into the site, sit back and wait for that Submit option to be active. You have not missed anything, nor have you “messed” something up.

This is most likely done to avoid having people submit totals, and then try to contact the CMTO to “add” or “modify” something. If the staff has to do this for 12000 RMTs; they will be wasting many, many hours that could be used for something else. We definitely do not want another reason for our fees to go up in any given year.

Mandatory Articles

Mandatory Articles are an easy 3 CEUs that every RMT will qualify for by reading all the CEU Articles in the TouchPoint magazine that were published during their cycle, and answering all the questions that followed. So really; all RMTs are responsible for obtaining their own 27 CEUs every cycle.

What seems to have people confused is exactly how to report them. The reason for this is; there is a two step process: First; record the CEUs earned, and second; verify you read them. In your report you can record all 3 CEUs on one line if you wish. Use ABA (activity code) CCL (competency code) and “Mandatory Articles from the TouchPoint”. try to find ‘where’ they should report them on their on-line forms. What will happen next is; after you finalize and “submit”, you will be asked to verify that you read the Mandatory Articles. This is because every single RMT will have this in common. The rest of our CEU’s will show an individual journey that each of us progressed through over a 3 year year stretch. These reports, being individualized, need to be fillable fields. There will be no individual verification for each one when you record them.

If you do not require the 3 CEUs (because you have tonnes); then you can just verify you read them without the need to record the 3 CEUs. So if you forget, and just submit; all you need to do is verify that the Mandatory Articles were read after submitting.

The CMTO is also now implementing a new component that allows RMTs to answer their Mandatory Article Questions through their CMTO account. This allows  the CMTO to have record, and proof, that did actually answer these questions.  Some RMTs will have seen this change already. What you will need to remember is that this is not enough. You are still required to have a physical record of the answers in your Portfolio. To do this you can simply print your answers and place the printout in your Portfolio.

Not Online

If you are not an RMT with direct access to the web at all times, or know someone like that, the RMT can still mail the forms to the CMTO. The catch is that the forms may be needed to be downloaded from, you guessed it, the web. An RMT can, however, request the forms be mailed to them through the Quality Assurance Committee. If this is the direction being utilized; please allow plenty of time to have them sent to you, and to send back to the CMTO. They are still required to be received by their office prior to December 31st. Considering that the CMTO offices shut down over the winter break; it is advisable to have them in prior to this break.

Chris Semenuk

Chris Semenuk

Registered Massage Therapist at Chris Semenuk Massage Therapy - London, Ontario
Chris graduated from massage therapy school in London, Ontario, in 2000 and has been an RMT since January, 2001. Immediately, Chris gave back to the sport that got him into massage therapy by volunteering with the Western Mustangs Track & Field team, and a few years later becoming part of the Cross Country team too. He was given the role as Head of Massage Therapy, which he holds to this day. In 2015 Chris served as a Lead Medical Practitioner for the Toronto Pan Am Games. Since 2001, Chris has focused on the clinical side of Massage Therapy, and was also a professor from 2001 to 2012. The pinnacle of his education career has been building the Fanshawe College Massage Therapy program in the summers of 2011 & 2012.

In addition to supplying sports massage to the Mustangs programs, Chris has been an Assistant Coach since 2011.
Chris Semenuk

Professional Portfolio Requirements for the Ontario Massage Therapist

Registered Massage Therapists in Ontario are asked by the Quality Assurance Committee of the CMTO (College of Massage Therapists of Ontario) to maintain a Professional Portfolio. This, simply put, is a place to physically collect proof of your Continuing Education activities while acting as an RMT. They require four (4) sections to be maintained at a minimum for each cycle (3 year term). Any other sections that are to be included are entirely up to the RMT to add. The process of creating, and maintaining, a Professional Portfolio does not have to be daunting.

According to the CMTO.com the four sections an RMT’s portfolio is to be divided into are:

  1. Completed Self Assessment Tool;
  2. A record of CEUs, identifying the number of Category A and Category B credits obtained, and which competency or modality each CEU relates to;
  3. Proof of CEUs collected including receipts, course attendance confirmations, conference brochures, etc.;
  4. Responses to questions from the mandatory CEU articles published in The College Standard.

Getting Started

Who sees this Portfoilio?

This is a question that gets asked a lot. Many RMT’s don’t understand why they must keep a Portfolio, and who may access it. The answer is really short; you, and the CMTO.

If you happen to be selected for a Peer Assessment, the Assessor will most likely ask for you to provide your professional portfolio. The Quality Assurance Committee may also request directly for you to submit your professional portfolio at any time. You must comply with this request in a timely manner.

They will be looking that you have completed the four sections, and they are up to date. They will also want to see that everything is contained within the same portfolio and not separate areas of your room or clinic.

Constructing the Portfolio

The simplest thing you can do for your portfolio is to keep all your papers in the same file folder (Yes, really, a single fold file folder in your cabinet) for a single, 3 year, cycle.

Files

image courtesy of Staples.ca

Another option is to use a hard cover binder to organize your items. This would be one of the most professional ways to maintain and store your originals, or hard-copies, of records for the Quality Assurance Committee. You can even include dividers to keep the four sections separate. These items, of course can be obtained from a dollar store or a business like Staples.

binders

image courtesy of Staples.ca

What is a Professional Portfolio?

A professional portfolio is more than just a requirement of the CMTO, it provides you with solid evidence that you have participated in learning. This also affords you the ability to examine your practice from a different angle.

Your portfolio is a collection of documentation that represents your learning experiences and outcomes. These documents will include: Your reflections, and answers, for the Mandatory CEU articles, records of CEUs you have obtained, proof of the CEU activities that you participated in, and your personalized Self Assessment Tool (SAT). This portfolio is most commonly utilized during a Peer Assessment, but can also be requested to be sent to the CMTO usually via the Quality Assurance committee.

Your portfolio is your responsibility to maintain as the CMTO recognizes that massage therapists are self-sufficient and competent members of their profession. You are expected to self-direct the maintenance of this important portfolio and are held fully accountable for it.

What does the portfolio do for me?

Your portfolio will benefit you by providing a place for you to reflect upon the activities you have participated in, the learning you have amassed, and fuse these into your active practice. You will have a tangible way to reflect not only upon your learning, but your preferred learning. It can chart a direction that you are steering your practice towards and answer that all important question; “where is my career going?”

A list of some of the things your portfolio can assist with

  • Identify areas of existing strength
  • Identify sort and long-term goals
  • Prioritize your future goals
  • Create plans to accomplish your identified goals
  • Gauge the impact of your learning on your practice

This can also be used to

  • Aid with your performance review (employee or independent contractor)
  • Prepare your CV (Curriculum Vitae, aka: Resume)
  • Prepare a Business Plan

Why have Professional Development?

First, and foremost, it is mandated by government legislation that all health care professions maintain high levels of competence and professional standards. But there is more to it than that.

As a health professional you have agreed to give the best possible care to your patients. You cannot do this by falling behind and remaining stagnant. You owe it to your patients to constantly update your knowledge, refresh your skills, and learn new things. Professional Development is, really, about being the best you can be for your patients.

The contributions of professional development to your practice are wide ranging. They allow therapists to maintain their relevance within the profession, as well as with other health care professions. It gives RMTs an ability to actually anticipate the changes that are occurring and to develop a plan to respond to these changes.

Self Assessment Tool (SAT)

The SAT was developed by the QA Committee of the CMTO to “help registrants (RMTs) identify competencies and areas that they feel need improvement and to develop a plan to address them”. This SAT is to be completed every three years (CEU cycle) by each and every registrant. The outcome of this completion is to be shared to the QA Committee.

The SAT is actually a personally subjective questionnaire developed with input from peers (what did you think those survey monkey things were for?) of the profession. It is intended to help you identify your current skill levels, and develop plans for self-improvement and enhancement. The CMTO is now switching to allowing RMTs to complete this tool online, but you are still required to print off a copy and maintain it in your physical Professional Portfolio.

This document will form the first section of your Professional Portfolio. It will not be fully completed until such time that you are near the end of your CEU cycle. It is expected that you begin this document at, or near, the onset of your cycle. To aid you with your current cycle; you can make a copy of pages 11, 12 and 13 from the SAT of your last cycle. This can be your reference for what you have planned to complete in the current cycle. If it is your first cycle, ie: new to the profession, you are expected to print off an SAT and complete it according to where you believe your entry-level skills rate. This will, again, serve the basis for guiding, and tracking, your activities in your cycle. Key point: do not wait til the end of your cycle.

The CEU Record

During your 3 cycle the QA Committee expects you to accumulate 30 CEU’s. These are calculated at 1 CEU for every 2 hours of activity. 20 must be obtained from Category A and the remaining 10 can be from Category A or B.

In this second section of the Portfolio you simply need to represent the sum of your CEU efforts. Therefore it can be a really short section using just the CEU Reporting Form (available as a download from cmto.com). In essence; at least two pages in length.

The CMTO is now having RMTs maintain a virtual copy their CEU Record in their personal portals at cmto.com. But, again, they are wanting you to have physical copies (printouts) maintained in your Portfolio.

Proof of CEU Activities

protectorThis third section will be the expanded version of the CEU Record section. This is where you will keep your receipts, course attendance record, brochures, copies of certificates, peer conferencing, articles read, seminars presented, articles written, (eg: The author is getting CEU’s for writing this), research Project work, etc…

 

If you are using a binder of some kind, then in this section you can keep “sleeves” in which to place smaller items, or items you don’t wish to damage with hole punches (ie: certificate originals). These can be as simple as a page protector.

Mandatory Articles

With the publication of each TouchPoint magazine from the CMTO, there are articles that are denoted as “Mandatory Articles”. Each RMT is expected to read these articles and complete a short questionnaire about each one. By reading, and responding to, all the articles in a cycle an RMT will earn 3 Category A CEU’s, maximum (meaning you now only need to get 17 Category A CEUs minimum).

The questionnaire may require a short essay answer to be written to show you obtained useful information from the article and can supply critical thinking when discussing it. Print out a copy of the questions asked and reference the source they came from. Place this printout, directly followed by the answer sheet, into your portfolio. Get these done as soon as you can, as the QA committee may request your Portfolio at any time, and they want to see you are up to date with the articles. This will also be true when a Peer Assessor comes to visit you.

Extras

That is it, really, and anything else beyond the above discussed 4 sections will be added at your own desire. Do not be surprised when your peer assessor skips right over the extras. It is’t a slight to you; they just do not require it as part of their check-list when they visit you. So, right now, you have the information needed to meet your minimum requirements for a Professional Portfolio.

 

References: cmto.com

Everything that is required for your professional portfolio base comes from the CMTO directly and can be found on their professional website. Any references that are used in this document are from the CMTO directly via their website. You can visit them at www.cmto.com to find these references. To create this document, of course, the author has navigated the website already and consolidated it for you. As of the publication date; all information is accurate to what has been released by the CMTO.

Chris Semenuk

Chris Semenuk

Registered Massage Therapist at Chris Semenuk Massage Therapy - London, Ontario
Chris graduated from massage therapy school in London, Ontario, in 2000 and has been an RMT since January, 2001. Immediately, Chris gave back to the sport that got him into massage therapy by volunteering with the Western Mustangs Track & Field team, and a few years later becoming part of the Cross Country team too. He was given the role as Head of Massage Therapy, which he holds to this day. In 2015 Chris served as a Lead Medical Practitioner for the Toronto Pan Am Games. Since 2001, Chris has focused on the clinical side of Massage Therapy, and was also a professor from 2001 to 2012. The pinnacle of his education career has been building the Fanshawe College Massage Therapy program in the summers of 2011 & 2012.

In addition to supplying sports massage to the Mustangs programs, Chris has been an Assistant Coach since 2011.
Chris Semenuk

Understanding the FSCO Service Provider role

FSCO HCAI fees for RMTs
It is very clear that many RMTs, and other Health Care Professionals, oppose the new Financial Services Commission of Ontario’s (FSCO) Service Provider License Registration being applied to RHPA Professionals and the accompanying fees. That topic has been discussed many times over, and will be discussed many times over. But; it is being rolled out, without question, on December 1st, 2014. All MVA Service Providers must be registered by November 30th, 2014 and are asked to have their application submitted by August 31st, 2014. So now it is time to focus on; what does it mean to RMTs and “how do you fit in”?

Do I need to register with FSCO?

The only Registration that you must legally maintain to practice is through the CMTO. The FSCO registration is only for Clinics/Service Providers wishing to bill an Auto Insurance Company directly through Health Claims for Auto Insurance (HCAI) and have them pay the RMT directly. The registration has nothing more to do with HCAI or the Insurance Companies.

The FSCO states a “Service Provider” must get a License to bill through HCAI. For all intents and purposes; the FSCO defines a Service Provider as:

1- Sole Proprietor

2- Corporation

3- Partnership

4- Limited Partnership

Can I still submit MVA Treatment Plans if I am not registered?

You can still use HCAI and submit the OCF 23 and OCF 18 without registering with FSCO. These are not affected by the changes that are happening with the Auto Insurance Industry through FSCO Registration.

If I am not registered; how do I get paid?

Billing the patient directly, and having them submit their invoices to their Insurance Company, will be the easiest way to avoid the FSCO registration. It is only the submission of the OCF 21 (invoice) through HCAI that requires obtaining a license.

Registering for the FSCO Service Provider License

Those are the easy questions, and answers, for people not wishing to register with the FSCO and not submit on-line direct billing in the future. The rest of this article will focus on helping people understand how to be part of the FSCO model if they do elect to do billing directly with HCAI.

Sole Proprietor

The first thing that has to be done is to identify what kind of business you own; for most RMTs, that will be the Sole Proprietorship. This means; you have a single-person operation and make the decisions about how your business operates. It will also mean that you will be required to pay the full $337 application fee, the $128 annual fee for each unique business location that you will be at, and finally $15 for each unique statutory benefit claimant. Unique claimant means each patient, and each time they have a MVA; not the number of OCFs that were submitted.

An example of a Sole Proprietor with multiple locations:

Joe Scapulat Massage Therapist works at Charles Mandibulane DC, Jennifer Hyoidson Physiotherapy, and also out of his home. Joe only treats MVA’s from the Chiropractic Office and Physiotherapy Clinic. In 2013, Joe treated a total of 14 patients. Therefore, Joe’s initial Licensing fee will be:

Application …………….$337.00

DC Location ……………$128.00

Physio Location ………..$128.00

14 x $15 ………………..$210.00

TOTAL ………………$803.00

Joe will need to pay $803.00 in his first year to be licensed through the FSCO. In subsequent years, it will be a minimum of $256.00 before the claimant fees are assessed, assuming he continues to provide post MVA care at 2 clinics.

The regulatory fee (defined as; the annual fee and the claimant fee) can be prorated though in the year of application. The application fiscal year for the FSCO Service Provider License is April 1 through to March 31 in the subsequent year.

The first year regulatory fee will be from Dec 1, 2014 to March 31, 2015; or 4 months. Therefore Joe’s fee would be prorated to $492.33 ($337 + $155.33) in that scenario.

Business models other than Sole Proprietorship

If your business type is any other besides Sole Proprietor, then the fees will be calculated in very much the same way, except they will be assessed to the business entity; and thus can be shared by all partners, or taken out of the profits of the business, or however the people who run the business decide to absorb it.

We will run another example below for these types of businesses. The Clinic has three locations, and each location accepts 2 new MVA patients per week, on average, for a total of 312 unique claimants per year.

Application …………….$337.00

Central Location ………$128.00

North Location ………..$128.00

East Location ………….$128.00

312 x $15 …………….. $4680.00

TOTAL ……………… $5401.00

Per clinic……………….$1800.33

For any of these business types, if you are the registrant, you will need to appoint a Principle Representative. This person will be responsible for filling out the application and complete the attestation. When you have decided who this will be, they can go to http://www.fsco.gov.on.ca/en/Pages/default.aspx and learn more.

Avoiding paying the full fee and minimizing your risk

This is most likely the section that a majority of RMTs will wish to follow, if you are looking to avoid paying the fees, or wanting to reduce the fees you could pay.

A RMT who works at a clinic, or multiple clinics, or even if they are a Sole Proprietor, has the ability to utilize said clinic’s FSCO License through their HCAI account. This means that you can still be an Independent Contractor and provide services at/for a clinic without having to register your own HCAI account.

Dependent Provider

In HCAI terms, this is for a practitioner who will supply services for a registered facility/service provider, but will have no capacity to access the HCAI system.

As the provider you, in simple terms, allow the facility to send in all forms electronically on your behalf through HCAI. You also agree to provide services on behalf of the facility and not submit forms yourself. But remember; it does not preclude you from supplying services to another facility/clinic and having them submit forms for you.

In this scenario you will most likely want to submit a paper version whatever form you want to use to the facility’s staff member who is the HCAI administrator. Be certain that the treatment plan has been approved by a Health Practitioner (OCF 23 or OCF 18) to start or continue a claim. The administrator can then transcribe the form for you into HCAI. They will also need to transcribe the appropriate follow-up invoices (OCF 21) for the submitted Treatment Plan.

To register with a facility under this type of arrangement the RMT must sign a Dependent Provider Form. Read this over, and determine further if this seems like the best option for your relationship with a facility/clinic/provider.

http://hcaiinfo.ca/Health_Care_Facility_Provider/documents/DEC%20Enrolment/DependentProviderTermsandConditions.pdf

Affiliated Provider

As an Affiliated Provider through HCAI you will be able to access the HCAI system. You will be provided with an HCAI User-ID that will allow you to use their system.

Being this type of provider means that; you will provide service for, and on behalf of, a registered facility. You will be able to access HCAI for submitting all forms, including the OCF 21, through the facility’s HCAI portal. Th facility will determine how much access you have. You may just have basic access to submit and view forms, or you may be granted access to manage the system. This will be between you and the facility.

You will still make paper versions of the OCF forms to keep for your records. These will help you to complete the online versions for submitting.

To register with a facility under this type of arrangement the RMT must sign an Affiliated Provider Form. Read this over and determine further if this seems like the best option for your relationship with a facility/provider.

http://www.hcaiinfo.ca/Health_Care_Facility_Provider/documents/forms/AppendixA_AffiliatedProviderForm.pdf

For both Provider types

By being either an Affiliated Provider or a Dependent Provider for all your MVA claims, you will not have to sign up individually to obtain a Service Provider License. This, of course, means that you will not have to pay the $377.00 fee to apply, nor the $128.00 annual fee. But it does not mean that you should outright expect to pay nothing.

For each MVA claim that you are part of, there will be a fee component that is assessed to the facility because of you. It will be crucial that you negotiate the terms of providing service ahead of time. Not having a clearly defined contract can result in you being levied with many fees that you did not plan/save for.

Some of the fees you will need to pre-determine how they will be absorbed, and who will absorb them, are the; 1) application fee 2) annual fee 3) per claimant fee.

It is my opinion that the clinic should be absorbing the one-time application fee of $337.00; as it is a “forever fee” and will essentially become less and less of an impact the longer the clinic exists. Plus it will apply to all providers who ever work for/with them, and it would be unfair for you to pay part of this fee when a subsequent provider will not. The fee should be considered part of the split the facility keeps from you and is thus paid from that revenue.

The yearly licensing fee should be absorbed the same way as the application fee, in my opinion. It should be absorbed by the clinic and considered part of the split collected by all providers in their facility.

By being a provider for the clinic you will be paying the facility monies already for rent/administrative fees. Therefore by having you provide a valuable service such as MVA care; you will already be making their investment worth more and pay them back more.

The $15.00 per claimant fee is the only real fee that is assessed sporadically and non-fixed; on a yearly basis. This is, in reality, the fee that needs to be negotiated as to how, and who, will pay. If you are the only provider on a claim then your claimant will generate a $15.00 assessed fee that will be charged to the facility in the following year. You can negotiate that this is part of your agreed upon split/rent, or you can agree to pay it separately. If you pay a split percentage to the facility; it is my opinion that it should be absorbed by the facility. If you pay rent, it is then my opinion that you should pay this fee to the facility above your rent.

Interpreting the Unique Statutory Benefit Claimant component

The FSCO has not been exactly clear on the interpretation of this component of their new licensing structure. But it does appear that it means for a single claimant who presents to the facility (Licensed Service Provider) for a unique MVA that they were involved in. This would mean that the $15 fee is assessed once per facility, per claimant, regardless of the number of providers who are involved in the case. Therefore the $15 will be assessed only once, and theoretically shared, amongst the providers.

Below is a chart to show the benefit of having a single registered provider over having multiple Licensed Service Providers within a single facility.

Examples

Clinic ‘A’ has 4 independent Service Providers; each with their own FSCO License. The Physiotherapist who owns the clinic has registered as the main facility. In a single year the clinic sees 100 individuals for post MVA care and each therapist is involved at some point.

Therapist Physiotherapist(Owner) Chiropractor Massage Therapist Kinesiologist
Annual License $128 $128 $128 $128
Per Claimant $1500 $1500 $1500 $1500
Totals $1628 $1628 $1628 $1628

Total collected by FSCO from Clinic ‘A’………………………..$6512.00

Clinic ‘B’ has decided to have the same set up and use 4 therapists to provide services to patients also. But the Physiotherapist who owns this clinic has decided to have each contractor work as an Affiliated Provider under her facility name. All the other parameters are the same as Clinic ‘A’.

Therapist Physiotherapist(Owner) Chiropractor Massage Therapist Kinesiologist
Annual License $128 $0 $0 $0
Per Claimant $1500 $0 $0 $0
Totals $1628 $0 $0 $0

Total collected by FSCO from Clinic ‘A’………………………..$1628.00

By pooling the resources of the professionals all working together, Clinic ‘B’ has saved $4884.00 in a single year over its twin clinic for the 100 unique claimants seen. This strategy, as I see it, is the most beneficial to everyone involved. This makes the Clinic ‘B’ model a strong point to negotiate from for your own contract to help cut costs. More importantly though; the whole Medical Team should look to adopt and take advantage of this model within a single facility.

The bigger the “facility” the smaller the costs.

How to help each other

Several RMTs will actually be Sole Proprietors working in a single location with other Sole Proprietor RMTs. Each of you will be required to pay the fee’s yourself separately, unless you decide to work together.

The principal RMT who is renting the space should be appointed as the FSCO Principal Representative. All other RMTs can then use that RMT’s HCAI account and become Affiliated Providers, at the same address, under them. You will all essentially become partners for post MVA care. As partners, it should be arranged to split the Application Fee and the Annual Fee equally. Each person should pay their own “per claimant” fees.

If you choose to do this; another option is to form an actual company. The cost of registering a business in Ontario, and using it to sign up for HCAI and a FSCO Service Provider License, can be cheaper than even 2 people obtaining separate Licenses. The name can be a “generic” Ontario business name with unique numbers following it assigned by the Government. Ie: Woodstock Massage Therapy Clinic 9876543212345 (Not verified as being unique). Only use this option if you are comfortable with creating and running a separate business entity as you will need to: create a bank account, do payroll/payouts (for each RMT), submit business taxes, etc..

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Sources

www.fsco.gov.on.ca

www.hcaiinfo.ca

Chris Semenuk

Chris Semenuk

Registered Massage Therapist at Chris Semenuk Massage Therapy - London, Ontario
Chris graduated from massage therapy school in London, Ontario, in 2000 and has been an RMT since January, 2001. Immediately, Chris gave back to the sport that got him into massage therapy by volunteering with the Western Mustangs Track & Field team, and a few years later becoming part of the Cross Country team too. He was given the role as Head of Massage Therapy, which he holds to this day. In 2015 Chris served as a Lead Medical Practitioner for the Toronto Pan Am Games. Since 2001, Chris has focused on the clinical side of Massage Therapy, and was also a professor from 2001 to 2012. The pinnacle of his education career has been building the Fanshawe College Massage Therapy program in the summers of 2011 & 2012.

In addition to supplying sports massage to the Mustangs programs, Chris has been an Assistant Coach since 2011.
Chris Semenuk