The Economic Affairs Interim Committee is wrapping up its study (SJR 27) of the Montana workers’ compensation system and MSF structure. One meeting on SJ27 remains in September.
Over the past year and a half, the Committee—made up of four democrats and four republicans (two of each from each chamber)—has heard from industry experts from across the country as well as Montana stakeholders. MSF has consistently held the position that we believe the current structure of a competitive workers’ compensation system is the best for Montana businesses and their employees – especially small businesses that have fewer market options. It is MSF’s position that over the course of the study, the facts and data have proven this to be the case.
Based on the facts and data presented to the committee, various alternative concepts have been withdrawn from consideration. For instance, a competing concept was to eliminate MSF altogether and replace the guaranteed market with a high-risk pool. Despite unfounded claims to the contrary, MSF was able to produce data showing that under a high-risk pool scenario, many of Montana’s small businesses would see rate increases. For this reason, and others, the committee opted to abandon the “elimination” option.
Current committee efforts are focused on making MSF look and operate more similar to a private insurance company. There are a few pieces of committee draft legislation in the works to accomplish these efforts:
MSF exemption from the Montana Information Technology Act (MITA).
Allow the State of Montana to explore a bidding process to cover state employees for workers’ compensation (exempting the university system and MSF).
MSF exemption from state procurement.
Election of a minority of MSF board members by MSF policyholders.
We have not yet seen final language on any of these proposals. Therefore, MSF does not at this time have an official position on them. However, we can tell you that conceptually these are very similar to how private companies do business and certainly could go a long way to level the playing field. It is our goal to provide our customers with accurate, reliable information regarding legislation that may impact them in a positive or adverse manner.
If you have any questions, please do not hesitate to reach out to Ethan Heverly, Director of Government and Community Affairs at (406) 495-5426.
Community Closet, a Livingston, MT based thrift store, is one our recent WorkSafe Champions graduate businesses. WorkSafe Champions is an elite safety education program offered to our policyholders at no charge. Over the course of eight modules, participants delve deeper into creating a safety culture at their workplace. The following story was taken from a Community Closet blog about their experience in our WorkSafe Champions program.
Community Closet is proud to announce our graduation from the year-long Montana State Fund WorkSafe Champion safety training and education program on May 30. We held a celebration to commemorate our graduation at the Park County Complex in Livingston. It was attended by Community Closet staff and volunteers, and representatives from the Montana State Fund, Leavitt Great West Insurance, Park County Emergency Management, and other community leaders.
Community Closet is grateful for the experience offered by this empowering program that emphasizes how to prevent workplace injury. “I feel very strongly about the power of this program,” says Community Closet founder and CEO Caron Cooper, “We’ve made huge progress as an organization through the WorkSafe Champion experience and education.” Community Closet employees and volunteers learned a great deal in the eight training modules about workers’ compensation, how to motivate and train employees, manage an incident, more effectively return an injured employee to work, and practical prevention techniques like body mechanics and lifting procedures. Mark Rosenleaf, Montana State Fund safety management consultant says, “We can’t be everywhere and our goal is to educate policyholders and give them the tools to identify hazards to put policy and procedures in place to mitigate hazards.”
Community Closet also received a grant-funded 24-bushel lift basket from Montana State Fund’s ACE (Assisting Charitable Endeavors) Program which will further enhance safety and prevent injury. Community Closet is dedicated to safety in the workplace for our employees, volunteers, and shoppers, including safety education about donated products and announcements about product recalls and items like unsafe baby products.
Thanks again to everyone who makes this powerful program run and to all those who participated and supported Community Closet in becoming a WorkSafe Montana Champion!
We are happy to introduce a number of new employees to the MSF Team. In the past few months we added five Customer Service Specialists, six Claims Examiner Trainees, a Safety Management Consultant and an Underwriter. These team member look forward to working with you to ensure our customers have an exceptional customer experience.
These new employees include:Customer Service Specialists
Travis Brower
Brenna Burgos
Marika Davis
Amanda May
Glen Grover
Claims Examiner Trainees
Jenni GrovomLayla Bullington-Hines
BriAnne King
Andrew Pitsch
Clare Stiennon
Shelley Widhalm
Safety Management Consultant (Kalispell)
Tim Mayhak
Underwriter
Amber Jellison
Thank you to all who attended our 18th Annual Medical Conference. Please find the Medical Conference Program from the two-day event. You can also review all of the speaker presentations on our website.
Mark your calendar for next year’s conference scheduled for May 16-17, 2019 in Helena.
MSF is approximately half-way through the development of the new policy and billing system. Erika Ayers, project manager, has the following to say:
“Although a lot has been completed and achieved, there is still a substantial amount of work left to do.”
“We constantly remind ourselves that this is a long-term, complex system being delivered and we are mindful that we need to keep our customers informed. We plan to send out regular communications to keep our customers up to date on latest news and development of the system.”
“In addition to the policy and billing components which MSF will be using, we are also building the access portal, through which agencies will interact with MSF. The most significant change for agents is going to be access to information.”
Some of the functionality that has been developed and that the team is currently working on includes:
The ability to submit applications online.
To offer multiple options of how a policy can be structured, such as,
Account : Policy
Account : Multiple Policies
Account: Policy with multiple legal entities (under evaluation)
The capability to make some policy updates online
To provide agencies with access to billing information including:
Billing/Payment History
Current Amount Due
A “Quick Quote” tool
“Although our ‘Go-Live’ date is at least a year away, MSF is starting to address training plans. Training will be provided to MSF’s staff and, as agencies are a key component of our plans, MSF will be identifying and meeting customers’ needs.”
“Customers are also regularly consulted for their input on features and tools that they would like to see in the new policy and billing system.”
MSF leaders, staff and the PBRI project team care about our customers’ and have a desire to help them by delivering a new policy and billing system that meets their needs.
MSF has reduced the account size required to qualify for an exception to the system assigned rate tier for new policies and for PY17 and PY18 renewal policies. If the account qualifies, MSF will manually calculate the rate tier to consider private carrier data or a combination of private carrier and MSF data.
Beginning 7/1/18, MSF will override the system assigned rate tiers if the new or renewal business meets all the following required conditions:
• The account must have 3 years of continuous coverage (i.e. 36 consecutive months counting backwards from the proposed effective date). The coverage must be continuous, but can be obtained through private carrier data only or a combination of private carrier data and MSF data.
• The new business account must be experience rated. The submission must contain the current experience modification worksheet or an authorization letter for MSF to obtain it.
• The account’s premium must be at least $5,000 as calculated by MSF3 (rate tier) multiplied by the experience modification factor. Previously, MSF required the minimum account size to exceed $15,000.
• The new business account must provide at least 3 years of currently valued loss runs with the submission.
All changes are calculated and approved by MSF prior to binding coverage. You may choose to send us the required information at any time prior to the effective date of the policy for our review and potential price adjustment.
If you have additional questions, please call Nick Hopkins, Director of Marketing and Business Development at (406) 495-5435 or Heather Domme, Marketing Service Specialist at (406) 495-5455.
We are pleased to host our annual CSR – CSS Conference. This two-day event is a wonderful opportunity for our Customer Service Specialists and our agency Customer Service Representatives to learn and share from one another.
Day 1 – Monday, October 1, 2018 9:00 a.m. – 11:00 a.m. Workers’ Comp 101 (Location – Montana State Fund) 11:30 a.m. Welcome Lunch (Location – Great Northern Hotel) 12:45 p.m. – 5:00 p.m. Continuing Education (Location – Great Northern Hotel)* Common Class Code Misconceptions
* Policy and Renewal Essentials
* MSF’s New Policy and Billing System Preview
* MSF’s Rebrand and the Customer Experience
6:00 p.m. Dinner at the Great Northern Hotel Day 2 – Tuesday, October 2, 2018 7:30 a.m. Continental Breakfast (Location – Great Northern Hotel) 8:00 a.m. – 12:15 p.m. Continuing Education (Location – Great Northern Hotel)* Ethics
* Workers’ Comp Claims
* Cyber Security
* Safety in the Workplace
We look forward to another productive conference. If you have questions, please contact Heather Domme (406) 495-5455.
Did you know that you can send your servicing team new applications, change requests, and policy questions through email? For Select team policies (under $15,000 in manual premium) email stfselectcss@mt.gov. For Premier team policies (over $15,000 in manual premium) email stfcsspremier@mt.gov.
Since these emails are monitored all day long, this is our preferred method of communication rather than emailing an individual who may be unexpectedly out of the office. When sending a change request or question, please include the policy name and number in the subject line.
You can also avoid mailing new application down payments by conveniently paying on line. To submit, go to montanastatefund.com. On the right hand tab click online payment, then choose Make a One Time Payment.
Over the years, Montana State Fund has been dedicated to providing exceptional trainings for our incoming agents and CSR’s. All new agents are required to attend a Producer Training before they can begin writing business with MSF. However; all agents, from the beginner to the experienced, are welcome to attend. Everyone benefits from this 50,000 feet view of workers’ compensation.
We will be offering this training again this fall in three locations: Billings, Missoula and Helena. Please mark your calendars – registration will open soon.
Producer Training 101 – an introduction to Workers’ Compensation
October 18 Billings – Double Tree
October 23 Missoula – Wingate
October 29 Helena – MSF
We are excited to announce that a more advance training is coming your way! This is not a required training, but we encourage all folks to attend. This training will focus on more advance technical topics and naturally build on the skills that you learned in our 101 training. The structure will remain the same, covering safety, claims and policy. We want you to be the expert!
Producer Training 201 – Becoming your policyholders Trusted Advisor
October 19 Billings – Double Tree
October 24 Missoula – Wingate
October 30 Helena – MSF
If you have any questions about the trainings contact Heather Domme at 406-495-5455.
The Economic Affairs Interim Committee is wrapping up its study (SJR 27) of the Montana workers’ compensation system and MSF structure. One meeting on SJ27 remains in September.
Over the past year and a half, the Committee—made up of four democrats and four republicans (two of each from each chamber)—has heard from industry experts from across the country as well as Montana stakeholders. MSF has consistently held the position that we believe the current structure of a competitive workers’ compensation system is the best for Montana businesses and their employees – especially small businesses that have fewer market options. It is MSF’s position that over the course of the study, the facts and data have proven this to be the case.
Based on the facts and data presented to the committee, various alternative concepts have been withdrawn from consideration. For instance, a competing concept was to eliminate MSF altogether and replace the guaranteed market with a high-risk pool. Despite unfounded claims to the contrary, MSF was able to produce data showing that under a high-risk pool scenario, many of Montana’s small businesses would see rate increases. For this reason, and others, the committee opted to abandon the “elimination” option.
Current committee efforts are focused on making MSF look and operate more similar to a private insurance company. There are a few pieces of committee draft legislation in the works to accomplish these efforts:
MSF exemption from the Montana Information Technology Act (MITA).
Allow the State of Montana to explore a bidding process to cover state employees for workers’ compensation (exempting the university system and MSF).
MSF exemption from state procurement.
Election of a minority of MSF board members by MSF policyholders.
We have not yet seen final language on any of these proposals. Therefore, MSF does not at this time have an official position on them. However, we can tell you that conceptually these are very similar to how private companies do business and certainly could go a long way to level the playing field.
If you have any questions, please do not hesitate to reach out to one of your customer service specialists at 800-332-6102. It is our goal to help you better inform your customers—our policyholders.
It was the culmination of nearly a year, but on April 30, 2018, Montana State Fund kicked off our brand refresh celebration. With the kick off came a refreshed mission, vision, guiding values and logo.
These new elements were driven and created by our employees. This refresh is the promise that we make and the reflection of everything we do, everything we say, how we say it and how we do it. It’s our reputation, both in the services we provide and as an employer.
Our Mission We partner with employers and their employees to care for those injured on the job and we champion a culture of workplace safety for our fellow Montanans.
Our Vision To be an indispensable partner in achieving a safer, healthier and more prosperous Montana.
Our Six Guiding Values (Click for definitions) Do what’s right Deliver with heart Focus on what matters Succeed together Find a better way Take the long view In addition, we refreshed our logo. We replaced our former teal color with fresh blues, and highlighted the word Montana in our name. We also eliminated the diamond that formerly surrounded the SF, which now gives it a freer flowing feel.
We are excited about this brand refresh and look forward to continuing our partnership with our customers and the people of Montana to make our state a safer, healthier and more prosperous to place live. Because in the end, everything we do together, does more.
Montana State Fund has entered into a contract with Rising Medical Solutions for medical bill review and payment services. During the next few months MSF will be working with Rising to insure that we have a seamless transition from ACS/Conduent. We anticipate the transition will be complete in December of this year. Our hope is that this implementation will be very smooth and not interrupt or change your business processes.
Some of the enhancements that Rising offers are the ability to electronically bill, issue EFT payments and a faster, more streamlined process.
You will be receiving updates and information from Montana State Fund and Rising in the coming months but, if you have any questions please do not hesitate to contact Michele Fairclough at 406-495-5362.
Montana State Fund received three communications awards at the recent AASCIF (American Association of State Compensation Insurance Funds) conference in Minneapolis.
The awards include: 1st place – Protect Your Parts: Young Worker Social media campaign. This campaign targeted young workers ages 16-24 through various social media channels including Facebook,
3rd place – Work Hard. Be Safe. Head Home statewide media campaign. In addition to the TV and radio ads, this campaign included print ads, online newspaper ads, YouTube ads and Facebook ads.
3rd place – Work Hard. Be Safe. Head Home radio/TV ads.
Our media campaigns and communication tools are focused on informing and educating Montana’s employers and employees about the importance of safety. Go to our safety focused website safemt.com to view all of our commercials, safety educational videos and WorkSafe Champion profiles.
Our 2017 annual report is now live on montanastatefund.com. Please take a few moments to review the work and accomplishments of the Montana State Fund staff.
Bill Status Please contact Conduent (previously ACS) for Bill Status. Please give 30 days before seeking a bill status or sending in a rebill. If you are not satisfied with the information from Conduent or have further questions that they are unable to answer, please call MSF.
Montana State Fund Medical Auditors – 800-332-6012 ext 5011
Bill Changes If a correction is made to a bill, please be sure the mark the bill as corrected, attach a copy of the Explanation of Review (EOR) if it has already been processed and the records if required. The corrected bill should include any other lines that were billed with the corrected line even if they have been paid. This keeps the integrity of the bill intact and makes it easier for processing the change.
Resubmissions Please wait 30 days before resubmitting a bill for processing after the original submission has been sent unless you have already received an EOR. This allows Conduent ample time to process the bill and will prevent multiple bills for the same services from slowing down the processing function. You can also call Conduent for a Bill Status check prior to resubmission to see if the bill is in review.
If you are submitting a reconsideration request with additional information or for another reason, please attach a copy of the EOR with the information and/or indicate the reason for the request. Please do not use a highlighter to indicate items or changes as these will scan black. Use a pen to “circle” or “star” an item you need noted.
Join Montana State Fund at our September safety workshops as we as we present, Stand Up for Safety. This training will give you the tools you need to help protect your employees from physical hazards and situational threats.
Topics include: Ergonomics: Ergonomics is more than buying your employees the same chairs or keyboards. It is the science of designing the job to fit each individual employee, rather than physically forcing the employee’s body to fit the job. In this session we will cover the practical implementation of a good ergonomic program and how your employees can benefit from it. Workplace Violence: Violence in the workplace is not only physical assault, it can be any act where a person is threatened, intimidated or verbally abused either in or out of the workplace. In this section we will discuss types of violence, how to recognize potential violent situations and what actions you can take to minimize possible threats to your organization and your employees. We will review active shooters scenarios, enhancing personal situational awareness and proactive plans or policies.
Dates and Locations September 5: Butte – La Quinta Inn September 6: Helena – Holiday Inn Express September 7: Great Falls – Holiday Inn September 12: Glasgow – Cottonwood Inn September 13: Miles City – Sleep Inn & Suites September 14: Billings – Hampton Inn West I90 September 18: Bozeman – Best Western Gran Tree Inn (New Hotel Location) September 20: Kalispell – Hampton Inn September 21: Missoula – Best Western Grant Creek Inn
Interested? Register Now. The free trainings take place from 8:30 am – Noon. If you have questions, call 800-332-6102 extension 5361 (Kirk Smith).
MSF is still receiving a high number of incomplete ICD-10 diagnosis codes. ICD-10 has been in effect since 10/1/2015. Most of the incomplete ICD-10 we receive are missing the 4th, 5th, 6th or 7th characters which add a level of specificity to each code. Codes are 3 to 7 characters (alpha numeric) with a place holder character of X used in many codes to keep open for expansion for future updates.
Correct and complete ICD-10 diagnosis codes are important to MSF for reporting requirements as well as having accurate information for meeting the needs of employers, injured workers and providers.
Physical, Occupational and Chiropractic therapies are the cornerstone for healing for many injured workers. This function plays an important role in getting workers back on the job and feeling better. Department of Labor & Industry posts Instruction sets for physical rehabilitation (see below for website links). These should be used in conjunction with the Montana Utilization and Treatment Guidelines (U&T) at http://mtguidelines.com/.
Services should be within the Utilization and Treatment Guidelines at www.mtguidelines.com.
If a physical therapy/modality is not listed in the Utilization and Treatment Guideline (U&T) or goes over the maximum threshold, services must be pre-authorized by Montana State Fund. Treatment should be directly related to the accepted part of body unless pre-authorized.
Timed Modalities (also applies to Facility services effective 7/1/2014) Services of less than 8 minutes when that is the only service performed during a visit is not billable. Time intervals are incremented in 15 minute units (base is 8 minutes):
8-22 minutes = 1 unit
23-37 minutes = 2 units
38-52 minutes = 3 units
53-67 minutes = 4 units etc
When more than one service of a timed modality is performed in a single day, the total minutes of the service performed should be included in the patient record to substantiate the level of service. A total of 8 units of active and passive therapy may be billed per visit. If active therapy is being applied, only two units of a passive modality may be included in the 8 units.
Passive therapies (listed in U&T Guidelines) will be limited to 4 units per visit, if only passive therapy is being applied. Note: Only 2 units may be billed if active therapy is being applied.
All timed codes must have the time documented (in minutes) in the office notes submitted for each code billed for reimbursement.
Therapy codes billed must have part of body documented or it must be clearly identified in a flow sheet or other attached documentation. If the procedures are clearly documented in the notes, a flow sheet is unnecessary. If the notes do not support the procedures billed but refers to a flow sheet then the flow sheet must be attached.
Passive vs Active
Passive modalities utilize a tool to cause an effect (i.e. electrical stimulation, hot/cold packs, iontophoresis, ultrasound, etc.).
Passive therapeutic proceduresare procedures that do not require energy on the part of the patient (i.e. massage, manual therapy, etc.) and are considered with the active therapy for purposes of the rule of Eights.
Passive Modalities
CPT Code
Description
97010
Hot or cold packs – one or more regions
97012
Traction – mechanical
97014
Electrical stimulation (unattended)
97016
Vasopneumatic devices
97018
Paraffin bath
97022
Whirlpool
97024
Diathermy (e.g. microwave)
97026
Infrared
97028
Ultraviolet
97032
Electrical stimulation (manual) one or more areas, ea 15 minutes
97033
Iontophoresis, ea 15 minutes
97034
Contrast Baths, ea 15 minutes
97035
Ultrasound, ea 15 minutes
97036
Hubbard tank, ea 15 minutes
97039
Unlisted modality, specify type and time if constant attendance
Active/Passive Therapeutic Procedures:
CPT Code
Description
Passive or Active
97110
Therapeutic Procedure, 1 or more areas, each 15 minutes. Therapeutic exercises to develop strength, endurance, range of motion and flexibility.
Active
97112
Neuromuscular re-education
Active
97113
Aquatic therapy with therapeutic exercises
Active
97116
Gait training (includes stair climbing)
Active
97124
Massage
Passive
97139
Unlisted therapeutic procedure. ** Passive or Active will depend upon the procedure.
Passive or Active**
97140
Manual therapy, ea 15 minutes. NOTE: This is passive unless billed with an active procedure – in that case it would be considered active.
Passive
97150
Therapeutic procedure(s), group (2 or more individuals)
Active
97530
Therapeutic activities, direct (one-on-one) pt contact, ea 15 minutes.
Active
97532
Development of cognitive skills to improve attention, memory, problem solving, direct (one-on-one) pt contact, ea 15 minutes.
Active
97533
Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) pat contact, ea 15 minutes.
Active
97535
Self-care/home management training, direct (one-on-one) pt contact, ea 15 minutes.
Active
97537
Community/Work reintegration training, direct (one-on-one) pt contact, ea 15 minutes.
Active
97542
Wheelchair management ea 15 minutes
Active
97545
Work hardening/conditioning, initial 2 hours
Active
97546
Work hardening/conditioning, ea addl hour
Active
97799
97799 Unlisted physical medicine/rehabilitation service or procedure. **Passive or Active will depend upon the procedure.
Passive or Active**
98940
Chiropractic manipulative treatment, spinal 1-2 regions
Passive
98941
Chiropractic manipulative treatment, spinal 3-4 regions
Passive
98942
Chiropractic manipulative treatment, spinal 5 regions
Order Reversing in Part and Affirming in Part Order Directing a Medical Examination
Summary: Claimant appeals an Order from the DLI directing him to attend a § 39-71-605, MCA, examination with a psychiatrist and an orthopedist. Claimant asserts that the DLI did not have jurisdiction to order him to attend an IME. Claimant also asserts the Insurer, which has not authorized him to see a treating psychiatrist or psychologist, is “stacking the deck” with “hired guns,” and that Insurer foes not have good cause for multiple IMEs. Insurer asserts that the DLI correctly ordered the examination with the psychiatrist because one of Claimant’s treating physician referred him to a psychiatrist or psychologist. Insurer also asserts that the DLI correctly ordered the examination with the orthopedist because Claimant’s condition has changed.
Held: The DLI’s order is reversed in part and affirmed in part. The DLI had jurisdiction. However, Insurer does not currently have good cause for an IME with the psychiatrist. Because of the potential for bias, an insurer may not force a claimant to attend an IME with a Psychiatrist of its choosing, who will provide no treatment. To balance a claimant’s rights with an insurer’s rights, the insurer must first authorize a treating psychiatrist or psychologist. Insurer has good cause for an IME with the orthopedist because Claimant’s condition has arguably changed, the previous IME was two years ago, and Claimant’s treating physicians can comment on the IME physician’s opinions.
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