6 Tips to Avoid Insurance Related Complaints
Posted On: October 18, 2019
Even though naturopathy is not covered by OHIP, most private health insurance providers offer full or partial coverage for naturopathic services. As a result, insurance-related issues are among the kinds of complaints that are received by the College.
This post highlights some of the requirements that NDs should be aware of to help reduce the likelihood of inappropriate claim submissions by Members or patients.
1) Maintain accurate and comprehensive appointment records for all patients, including:
• date and time of appointment,
• name of patient (minimum last name and first initial),
• nature of treatment provided, and
• length of appointment.
Insurance investigations may take years. In the course of a fraud investigation, a naturopath may be asked to disclose records for appointments held years ago. The Standard of Practice for Record Keeping states that all patient records must be kept for at least 10 years. If you do not use specialized software, you may need to back up electronic calendars (Outlook, Google, etc.) to ensure that appointment records are readily accessible in the future.
2) Provide accurate receipts. Invoices and/or receipts issued to patients must identify:
• the fees charged, your name and registration number;
• clinic’s name and address;
• patient’s name and address; and
• date and description of the services provided.
You must ensure that fees for naturopathic consultation are separated from all other fees, and that fees for supplements, injectable substances, devices, special testing, etc., are individually listed.
3) Communicate with insurance providers. Timely responses and appropriate information disclosure will help insurers resolve any issues arising from a questionable claim. The Personal Health Information Protection Act allows you to disclose your patients’ information to an insurer for the purpose of confirming whether the services were provided.
It is also important to note all communication you have with an insurer in the patient’s
4) Use your best judgement. The Inquiries, Complaints and Reports Committee occasionally investigates matters where a naturopath:
• scheduled unnecessary appointments with a patient to “help” them use up their benefits for the year;
• issued receipts for services that were not provided at the request of the patient or employer;
• created clinical (SOAP) notes for appointments that never happened and provided these notes to an insurer.
Remember that providing unnecessary services and falsifying a record related to your practice constitute professional misconduct.
5) Be responsible. Although someone else in your office may schedule appointments and issue receipts on your behalf, it is your ultimate responsibility to ensure that the appointment and financial records comply with the professional standards of practice. It is also up to you to familiarize yourself with instructions provided by individual insurers for submitting claims.
6) Report potential fraud. Last but not least, if you become aware of your name or registration number being used by another individual, immediately notify the insurer and the Professional Conduct department of the College at firstname.lastname@example.org.