Standards

Resources: Fees, Billing and Accounts

Written Process for Auditing Billing

All physiotherapists must routinely audit billing done using their name and registration number. According to the Fees, Billing and Accounts Standard:

Physiotherapists must have a written process for routinely reviewing their fees, billings or accounts. This review must ensure that:

  • Any fees charged are accurate and reasonable
  • Billings or accounts are accurate

Physiotherapists must be able to demonstrate that they did the review.

So, how would a PT go about writing a process for auditing billing?

It’s ultimately up to the PT to rationalize the sample of billings reviewed based on the volume of patients seen and the billing risk. The PT verifies that the information on the invoice is consistent with the patient’s file. The comparison should include verifying that the patient’s name, the PT name and registration number, the date and costs for the services or products on the invoice are accurately reflected in the patient’s file.

Here’s an Example of a Written Process

Billing Review Process

R. Smith, Registration Number: XXXXX

  1. On the first day of each month, I will obtain a record of all of the previous month’s billing done using my name and registration number.

  2. I will audit this billing record by randomly selecting 20% of invoices for each funding stream. I will also obtain clinical records for each patient selected for the audit as they contain the dates and descriptions of each patient encounter and can be used to cross-reference billing records. I will determine if:

    1. Services billed for were actually provided by R. Smith, PT.
    2. Services billed for were actually physiotherapy services.
    3. Fees were not charged for any services that have already been paid in full.
    4. Services billed for were not excessive. I will compare the billing record to the fee schedule for assessments, treatments and re-assessments for each funding stream.
    5. All services provided were billed for (e.g. none are missing from the billing record when checking all billings)

  3. I will check all billings for the month if more than 10% of billings reviewed contain inaccuracies. For the first month at any new job, I will check all billings.

  4. After the above review, I will sign off on the audited billing record and retain it to demonstrate that a review was done each month.

  5. If any inaccuracies are discovered I will take the following steps:

    1. Contact payers and cancel or correct any incorrect invoices
    2. Document the inaccurate findings and action taken along with the outcomes

Example of an Audited Billing Record

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