Expectations regarding fees, billing and account oversight Flashcards
Clinic fee schedule
Services
- Initial, subsequent session
Other services & products
- Braces, exercise equipment
- PTA sessions
Administrative task
- Photocopying a Pt record, filling out forms
Penalties
- Interest charges for account owing
- Cancellations/missed appointment
- PT: ensure Pt are notified of unpaid invoices
Ensure the Pt is aware of the total expected costs for Rx based on the proposed frequency, duration and length of Rx
Billing practices
- How often bills will be charged
e.g. after every service, at the end of each month - Receipts will be provided at no cost if requested by the Pt/payer
How to relay info about Clinic fee schedule & billing practice
No specific requirement that state how those shoulde be present
A clear system should be in place to ensure that Pts are provided with relevent fee information and billing expectations
Info can be present through
Verbal discussion
PT: - discuss with each Pt before starting Rx to ensure they understand the costs associated with every aspect of their care
- Ask the Pt any questions related to fees
Any member of the care team who has a clear understanding of those
PT need to ensure accurate information is being relayed
PT responsibility when others bill for you
- accuracy and reasonableness
- Responsible for ensuring that my billing practice meet ON college expectations and standard
I understand - All costs of my service
- How my billing number is used
- Policies around billing at the clinic where I work
- My name and registration no. should never be used to charged a fee or create a receipt that is inaccurate or misleading
- Only 1 payer should be charged for the cost of PT session
Periodically monitor invoices and billing practices to ensure they are correct & look for mistakes.
Check for:
- PT name & registration no.
- Pt name
- Date & Cost of service
If inaccurate billing…
- Reasonable steps to remedy the situation
E.g. Pt was charged an IA fee for a FU session
- Notify the front desk & ask them to contact the Pt to refund them the difference
- FU to ensure that refund was completed
- Bring this to the attention of my manager/clinic owner + review future billings
- Document the finding in Pt’s chart & steps taken to address the issues
Having gaps in the current schedule and start to see some Pt from the personal trainer as they are covered for both PT & personal trainer service.
Benefit fraud
- Although it doesn’t hurt the Pt to see both you and the personal trainer–>Issue:treat Pt to fill my caselaod as the Pt has coverage
Seeing a Pt more than necessary because they have funding through a 3rd party that will pay for service is fraudulent
- Care should be provided only based on the Pt’s need but not based on what the 3rd-party payer will pay for. Under no circumstance shoulder PT be heping Pt defraud their insurance company
- I would not increase the frequency of the Pt’s appointment based on the fact that I have openings in my schedule
Pt needs should always come first
Billing session with personal trainer(PTA) as session with PT as Pt only have coverage when with PT.
Not appropriate
- Invoice must clearly indicate the individual who was providing treatment
- Session with PTA should be reflected in the invoice
My registration number may be included on the invoice provided as I am overseeing the program
- But the invoice must clearly indicate that the session was with support personnel
Pt request the cost of Rx on receipt to be higher so they can fully reimburse.
Not accept the request
the receipt must reflect the exact cost of Rx and what was paid by the Pt
Failure to do so is fraudulent
- Receipts must also reflect the exact service that was provided (PT vs PTA services)
Suggest alternative
- session with PTA
- HEP
- Discounted session if I was providing this option of my own free will
Receipt need to reflect the actual cost of the session(after discount)
**Service provided must be of same quality
Pt can no longer afford to pay for PT services
PT are not required to offer fee reduction if a Pt cannot pay for their Rx
openly discuss alternative Rx options
- PTA session
- HEP
and what Rx are a priority for their specific situation
- Ensure Pt is able to make an informed decision about what treatment (if any) they would like to receive based on what they can afford
Can offer a reduction in the cost if I provide this option of my own free will
- I will check with the clinic management to ensure they agree if I offered a reduction in the cost of session
If Pt agrees to pay for session at a reduce price
Receipt: reflect actual cost of services
- Care provided would need to be the same level as someone paying full price
Can you accept a lower fee for certain groups (e.g. students)?
Yes, PT can accept a lower fee than is documented on the fee schedule and are thus allowed to dec. the cost per session for students if they choose to.
Fee can only be reduced and can never be increased based on a Pt’s ability to pay
If fee reduced for a session
- Providing same level of care as it would be for someone who is paying a normal fee
Pt ask for copies of their clincial record, can charge?
- Yes, the clinic can charge for this but only a fee for administrative costs (e.g. paper cost, time for admin to copy all records)
- Health professionals are required to provide a copy of a Pt’s clinical records within 30 days of the request
Pt offer to trade service for ongoing PT services
PT responsbility to ensure no exploitation of the Pt
- Accept the trade–>dual relationship (a relationship exists within & outside of the therapeutic relationship)
Blur profeesional boundaries
- I could offer to lower/waive my fees if this was something I felt comfortable doing
- I would document the agreement for lower/waived fees in the Pt’s chart
Bought bundled service: Pt request to stop PT but I feel the Pt can benefit from continuos PT Rx.
Respect Pt’s decision
- Educate the reason for ongoing PT service is beneficial and the risk that could occur if not continuing
- Educate the Pt on home management strategies for continued success
- Offer the Pt a refund for unused service/allow them to keep the unused service on file for future use
Document the interaction and DC the Pt from active care
What Pt should know for bundle package?
What services are included in the bundle
- Cost of each individual service+total cost of the bundle (Clearly provided on the invoice)
- Option to receive a refund for any unused service in the bundle
- Option to purchase each service individually
- Standard of care must be maintained as same as the service for a full paying Pt
Teaching Pilates lesson, Pt request to bill as a PT session.
I would advise the Pt that I can only provide PT receipt if PT service are provided
Invoice must be clear and transparent
- If 1 on 1 pilates training= billed for Pilates
- If use a few Pilates exercise during a PT Rx to achieve a PT related goal (inc. core strength), then the session can be billed as a PT session.
