Funding, Fees and Billing Standard

Standard 

The physiotherapist is responsible for ensuring that the fees charged for physiotherapy services and products are transparent, justifiable, and not excessive, to enable patients to make informed choices. 

Expected outcome 

Patients can expect that fee schedules and billing practices for physiotherapy services and products are transparent, justifiable, and clearly communicated, and that they will be made aware of the fees and billing practices of the physiotherapist before they become subject to them. 

Performance expectations 

The physiotherapist: 

• Is responsible for all billing under their registration number. 

• Maintains reasonable knowledge of relevant funding sources for physiotherapy services and complies with funding requirements, policies, and procedures. 

• Prior to the patient being subject to any fee, confirms the patient has been provided a comprehensive fee schedule that includes transparent and accurate information about billing policies and all potential charges, including but not limited to:    
  • Assessment and treatment fees. 
  • Reports and fees for copies of patient records. 
  • Equipment and any additional fees.  
  • Fees and policies related to bundled physiotherapy services. 
  • Cancellation or late fees and interest charges. 
  • Refund policies. 

• Knows that any departure from the established fee schedule can only be to reduce fees. 

• Explains the fees and billing process to their patients that is related to their care and makes a reasonable effort to ensure that patients understand this process. 

• Establishes fees for access to patient records that are: 
  • aligned with the principles and parameters outlined in applicable legislation, including the Personal Health Information Protection Act (PHIPA), 2004, 
  • reflect the costs of providing a copy of the patient record, and  
  • are consistent regardless of the party requesting access. 

• Promptly provides patients and/or payors with clear, transparent, accurate, and comprehensive invoices or receipts along with any necessary explanations so that the patient and/or payor understands the fees charged, who provided the care, and terms of payment.   

• Does not represent non-physiotherapy services as physiotherapy on invoices or receipts.   

• Routinely reviews their fees, billings, or accounts, and can demonstrate that they did the review, to ensure that: 
  • Any fees charged are accurate and reasonable, and 
  • Billings or accounts are accurate. 

• Identifies and takes reasonable steps to correct any billing errors and documents the findings, action taken, and the outcome. 

• Employs policies and measures to mitigate the risks related to pre-payment of physiotherapy services before accepting pre-payment or engaging in bundled physiotherapy service provision (other than bundled fees required by a predefined third-party payment plan), including but not limited to: 
  • Providing the patient with the option to purchase one service at a time. 
  • Providing refunds for unused physiotherapy services.   
  • Issuing physiotherapy receipts only after physiotherapy services are delivered. 

• Makes reasonable efforts to resolve issues arising from billing disputes.