Fees, Billing and Accounts

FAQs: Fees and Billing Practices

• I’ve heard rumours about shady business practices at a private clinic I used to work at. Is there any way I can verify that my name and registration number were used appropriately?

  It may be difficult to identify that a business or a patient is billing inappropriately for extended health benefits care unless a problem has been identified during an audit conducted by an extended health insurer. But for auto insurance claims, PTs do have the ability to ask the College to check the Professional Credential Tracker (PCT) provided by Health Claims for Auto Insurance (HCAI). The PCT uses HCAI data to identify who has a health professional’s credentials. To access the PCT you would need to contact the Practice Advisor to provide your name, registration number and an email address where your report can be sent. Contact the Practice Advisor at advice@collegept.org to request a PCT report. You can also get information about reporting errors.

  Some of the possible problems noted in the PCT Reports are:

  - Listings that include variations on the spelling of your name

  - Profession is incorrectly identified

  - Previous employers have not submitted an ‘end date’ when you left the practice 

  - PTs find clinics listed on the report that are unknown to them

  - A different provider name is on your report

  - A facility where you deliver care to MVA patients is missing from your report

  - The report does not include a list of specific patient names or treatment dates. 

• A patient’s treatment costs $40 but the insurance company only reimburses 80% so the patient asks for a receipt for $50 so they don’t have to pay anything out of pocket. How should I respond?

  Receipts should only be provided when money is actually received and should reflect exactly the service that was provided and the exact amount collected. Anything else is fraudulent.
  
  Care should only be provided based on a patient’s need, not in anticipation of what the insurance company will pay for, and under no circumstance should PTs be helping patients defraud their insurance company!

• Sometimes I recommend exercise programs or personal training for my clients who have physiotherapy coverage. Can I bill these activities as physiotherapy?

  Many times physiotherapy treatment involves exercise prescription. A PT uses judgement and collaborates with a patient to determine if they will be able to participate in the exercise plan with a personal trainer independent of a PT or will need the guidance and close monitoring by a PT. The latter scenario is physiotherapy. It should include all the required elements of assessment, treatment planning, outcome measures, documentation etc. Your services should align with what the patient needs and not what you are able to bill insurance for.

• Where I work all the billing is taken care of by the office manager. Is this ok?

  Physiotherapists are responsible not only for the services they provide, but also for the accuracy and reasonableness of the fees charged for their services. While it is permissible for another person to manage the billing on behalf of the physiotherapist, it is the responsibility of the individual physiotherapist to ensure that the billing practices meet the Fees, Billing and Accounts Standard.
  
  Physiotherapists should maintain knowledge of, and control over, billing. For example, physiotherapists should understand the fees that are being charged for their services, how their registration or billing number is being used and the organizational policies that exist with respect to billing. It is also important that physiotherapists periodically monitor invoices and billing practices to ensure accuracy, and should any inaccuracies be discovered, that reasonable steps are taken to remedy the error.
  
  Written Process for Auditing Billing

• Can I use my name and registration number on the invoice so my patient can be reimbursed for their massage therapy treatment?

  No,you must only use your name and registration number to bill for physiotherapy services. The College has adopted a zero tolerance policy for inappropriate business practices. Signing or issuing a document that is false or misleading could be viewed as professional misconduct. 

• Can I offer “package deals”? For example, selling treatments of 5 for $200 rather than $50 per session?

  Charging a set fee for a block of services may be permissible provided certain conditions are met. These conditions are described in the Professional Misconduct Regulation which states that the services included in the block should be specific to the patient and the patient should be given the choice whether or not to participate.
  
  Should the patient require fewer sessions than what they have purchased, the difference should be refunded. Otherwise, the invoice would not accurately reflect the service that was provided and the fee could be considered excessive for the service that was received.
  
  Refer to the Fees, Billing and Accounts Standard