ON Chiropractic
that any person authorized to act on behalf
of the service provider is complying with
the above requirements.
Policies and procedures are required to
ensure that no information submitted to
the insurer is false or misleading, whether
the information is submitted by the service
provider or anyone else associated with the
claim. If a service provider believes that
false, misleading or deceptive information
has been submitted to an insurer, the
service provider has a responsibility to
advise the insurer within two business days
of forming such a belief.
Record retention policies should
ensure that records are secure and cannot
be falsified, and that you are able to retrieve
specific records within five business days
upon request.
A complaints process must also be
developed so your business can respond
completely and promptly to complaints
from auto insurers related to your business
systems and practices in connection with
listed expenses. Service providers must
ensure that the email address provided to
FSCO is current and checked regularly so
these communications are not missed.
Finally, a review of documents
submitted to insurers must be conducted
periodically to ensure that your business
remains in compliance with the law and all
applicable guidelines. If your business was
paid $50,000 or more for listed expenses
by auto insurers in the calendar year before
the review, you must conduct a review
every three months. If your business was
paid less than this, then you must conduct
a review every 12 months.
It is highly likely that chiropractors
already have these policies and procedures
in place in at least an informal way. If
that is the case, you will simply need to
document the procedures appropriately.
The OCA will host a webinar in March
2015 to help you ensure that your policies
and procedures are up to date in the event
of a FSCO audit.
Learn More
If you have questions about FSCO Service
Provider Licensing, you can contact FSCO
by email at [email protected]
or by telephone at 416-250-7250 (toll-free
at 1-800-668-0128).
{
Online resources include:
• FSCO Guide to Service Provider
Licensing: http://www.fsco.gov.on.ca/en/
service-providers/etoolkit
• OCA information and webinars on
Service Provider Licensing: http://www.
chiropractic.on.ca/fsco-service-providerlicensing
GETTING PAID WITHOUT A SERVICE
PROVIDER LICENCE
1
Submit your treatment plan and OCF-21 through HCAI as
usual.
2
Provide a hard copy of the HCAI-validated OCF-21 to the
claimant for submission to his/her insurer.
3 your patient to mail the OCF-21 to their insurer. The
Tell
insurer will then adjudicate the claim and pay your
patient directly.
4
Collect payment directly from the patient. Whether you
do this before or after they receive payment from their
insurer is at your discretion.
UPCOMING WEBINAR
Preparing for a FSCO Audit
March 25, 2015 at Noon
Members will be guided through developing the
requisite policies for their clinic staff and the
procedures for FSCO compliance.
www.chiropractic.on.ca
17