Masseurs-Physiotherapists

To be eligible for reimbursement by the National Health Fund or the relevant public sector fund, all physiotherapy acts must be prescribed by a doctor and the prescription must be validated by the CNS. Prior validation allows me to confirm that the costs of treatment will be covered by health and maternity insurance before starting treatment that extends over several sessions.

Request for validation by the insured person

If the insured person requests validation, they must send the original medical prescription by post to the CNS. The CNS will then send them a certificate of coverage or a written refusal stating the reasons. If authorization is granted, they can come to my office and give me the prescription and the certificate of coverage.

In this case, direct coverage by the CNS (third-party payment) is excluded.

Request for validation by the physical therapist

Submitting the request for validation directly by myself, as a physical therapist, offers several advantages over a request made by the insured person. Electronic communication between me and the CNS allows for faster and more reliable data transfer. In addition, in order to apply the third-party payment system, the request and the certificate of coverage must be submitted electronically.

After scanning the prescription provided by the insured person and entering the necessary information using a suitable IT tool, I send the scanned request to the CNS. I will receive a response within one working day (except in exceptional cases). This response, also sent electronically, will either be a refusal with reasons or an authorisation with a certificate of coverage number, the period of validity of the certificate and details of the services covered.

Upfront payment by the insured

At the end of treatment, I will provide the insured with an invoice for the total amount payable, i.e. the portion covered by health insurance and the portion payable by the insured.

After payment, the insured person must apply to their competent fund (CNS or public sector health insurance fund) for reimbursement of the portion covered by health insurance.

Application of the third-party payment system

As a physiotherapist, I cannot apply the third-party payment system if the insured person has requested a certificate of coverage from the CNS themselves. In other cases, I must apply the third-party payment system if the insured person requests it and for services provided to persons within the competence of the Accident Insurance Association.

The portion of the costs not reimbursed by the health insurance fund must be invoiced directly to the insured person.

To obtain payment of fees reimbursable by health insurance under the third-party payment system, I send my fee statements to the CNS electronically. I can include all sessions performed without having to wait for the end of a series of treatments (several sessions prescribed by a prescription).

The procedures for preparing and sending invoices to the CNS are set out in the specifications annexed to the agreement between the CNS and the ALK, and are detailed under the “Electronic data exchange” tab on this page.

After processing, the CNS sends me an electronic file containing all the information and reasons for invoices that are not or not fully reimbursed, and pays the amount due within a deadline of 30 days.

The practice of physical therapy in a liberal association with shared fees is linked to the creation of a common service code. All acts performed by members of the association can be invoiced under this association code.

Unlike other forms of joint billing, professional associations are characterized by greater stability and transparency among their members. In practical terms, this translates into the following practical arrangements:

• Each member of the association must confirm the membership or departure of a member by signing a document.
• Each member of the association receives an annual statement of the amounts charged to the association for the period during which they were a member.
  

To request an association code or to notify the CNS of a change in the composition of an existing association, the form “Practice of physiotherapy in a liberal association” must be used.

Self-employed physiotherapists, physiotherapist associations, care and assistance institutions, care and assistance networks, and semi-residential centers are entitled to invoice services provided by individual physiotherapists other than the invoicing physiotherapist, provided that the relationship between the billing physiotherapist and the physiotherapist providing the service is reported in advance to the CNS. In this context, both an employment relationship and work under a contract for services (also known as “freelance”) are permitted.

The CNS will only cover fee statements that include a performing physiotherapist who has been previously declared as a member of the billing practice or establishment using the form “Départ et/ou adhérence à un groupement de masseurs-kinésithérapeutes à facturation commune (non regroupés en association libérale)(Departure from and/or joining a group of physiotherapists with joint billing (not grouped in a liberal association))”.

To receive the latest information by email, I subscribe to the newsletter for service providers: CNS Update.

For any questions relating to day-to-day dealings with the CNS, particularly regarding authorization and invoicing procedures, I should contact: infokine.cns@secu.lu