Understanding the FSCO Service Provider role

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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..

______________________

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

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.