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Shenda Tanchak
Registrar and CEO
College of Physiotherapists of Ontario

  • Delisted – Make Sure it Doesn’t Happen to You

    May 24, 2018

    A head shot of Fiona Campbell. She is smiling.






    Guest Blogger: Fiona Campbell, Senior Physiotherapy Advisor 


    What is delisting anyway?

    Recently, a few PTs have called me shocked and embarrassed after discovering they’d been delisted by one, or more, of the major insurance providers. 

    Delisting of a physiotherapist by an insurance provider means the costs for services from the PT are no longer covered. Patients may be left to cover their own treatment costs and may go elsewhere for care. In many cases neither the PT nor the patient are notified of the delisiting – not a pleasant surprise when you’re expecting a reimbursement. 

    Why are insurance providers delisting health professionals?

    Fraud or abuse of benefits is big business, so it’s no surprise insurance companies have reacted by employing teams of investigators to gather data, conduct audits of health care facilities and use analytics to identify irregular billing patterns and potential fraud. 
    Fraud is an intentional deception that can result in unauthorized benefit. For example, submitting claims for services never given, falsifying claims or patient records, and frequency or description of services rendered. 

    Abuse, on the other hand, is defined as actions that are improper, inappropriate, outside of acceptable standards, or clinically unnecessary. Common examples of abuse include bad billing practices, failure to maintain accurate records and a pattern of claims for services not medically necessary. 

    I spoke with representatives from the insurance industry and they said audits that show evidence of the above examples, or a discipline history may trigger their decision to delist a PT. Audits of health facilities are increasing so there’s a good chance that if you’re working in, or own a private practice, you have or soon will participate in an audit. New grads or anyone new to physiotherapy should be careful when looking for work as there are some employers who make it difficult to follow the rules. Don’t get caught in someone else’s poor business practices and end up paying the price. Even if you change employers, there’s a chance you will remain delisted. 

    While the College has no power over insurance agencies and their decisions, we can increase your awareness. So, are you at risk of being delisted? 

    Ask yourself these eight questions:

    1. Do I document in each patient file a correct physiotherapy diagnosis based on subjective and objective measures?

    2. Do I develop and document a clear treatment plan?

    3. Do I use outcome measures to support my rationale for treatment?
     
    4. Do I document the dates a patient attended and the name of the person who provided the treatment?

    5. Am I really supervising the care being delivered by PTAs or are they practicing independently?

    6. Do I routinely check and document the accuracy of billing using my name and registration number? 

    7. Do I have an agreement with my employer as to the appropriate use of my name and registration number for billing purposes?

    8. If I stop working at a clinic, do I have an agreement that no further invoices/claims will be made with my license after my date of departure?

    Don’t get delisted. Follow the rules and standards, provide safe, effective patient care and routinely check the accuracy of billing done using your billing number. 

    If you have questions, please get in touch with the Practice Advisor team at 647-484-8800. It’s free and anonymous and our job is to help you get the information and answers you need. 

     
    Fees, Billing and Accounts Standard

    Questions? Contact the Practice Advisor

    A blog by Fiona Campbell, Senior Practice Advisor at the College of Physiotherapists of Ontario, explaining how and when a physiotherapist may be delisted by an insurance company.
    Full story
    • Delisted
    • Delisting
    • Abuse
    • physiotherapist
    • Billing Number
    • billing
    • Insurance Fraud
  • A Bedtime Story

    Apr 27, 2018
    Full story
    • billing
    • assistant
    • physiotherapist assistant
    • PTA
    • Fraud
    • insurance
    • massage therapist
  • Who Runs the College Anyway?

    Mar 02, 2018
    Full story
  • Did You Make a New Year’s Resolution to Lose Weight this Year?

    Jan 22, 2018
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  • The Assessment Program Undergoes An Assessment

    Dec 07, 2017
    Full story
  • Harvey Weinstein

    Oct 16, 2017
    Full story
  • The Common Denominator: Billing, Registration, Professional Identity

    Sep 07, 2017
    Jamie G. Dockx, PT Student Clinical placement at the College of Physiotherapists of Ontario   I have had the privilege of spending 5 weeks at the College of Physiotherapists of Ontario for my final student placement. After 4 clinical placements, it was time to learn the ins and outs at the College. Learning about the […]
    Full story
    • Policy
  • What’s Your Ism?

    Aug 09, 2017
    How do your conscious or unconscious biases affect your ability to provide safe and effective care for patients? If you work in a private practice setting, think about your office for a minute. Do you have posters for promotion or décor?  Do you have gym equipment?  Is there any chance that these décor elements might […]
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    • Auto Insurance Anti-Fraud investigation
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    • clinics
    • College
    • College Council President
    • College of Physiotherapists of Ontario
    • comment
    • Consent
    • CPO
    • décor
    • designated OHIP clinics
    • disabled
    • elderly patients
    • funding changes
    • funding model
    • generate discussion
    • health care
    • health care fraud
    • inappropriate billing
    • Jenny Setchell
    • mental illness
    • obesity
    • physiotherapy
    • regulatory
    • self-regulation
    • Shenda Tanchak
    • Stigma
    • The College
    • World Congress for Physical Therapy
  • In It Together

    Apr 25, 2017
    You run a clinic. Your receptionist is rude. Your physiotherapist assistant bills for services not provided. Your brand-new PT burns a patient with a heating pad. Whose responsibility is all this? If you guess that you’re on the hook for behavior by those you employ or supervise, you are right. You work for a clinic. […]
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    • take action
    • testimonials
  • Doing The Right Thing – Nobody Said It Was Going To Be Easy

    Feb 03, 2017
    Have you heard of convicted serial killer Harold Shipman? He was a UK doctor found guilty of killing 15 of his patients. After his conviction, a two-year inquiry spearheaded by the British government revealed that he had in fact killed an upward of 250 patients throughout a 23 year span. Shipman’s killing spree began to […]
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    • blog
    • clinics
    • College
    • College of Physiotherapists of Ontario
    • doctor
    • Dr. Shipman
    • health care
    • investigations
    • Nurse
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    • Ontario
    • patient safety
    • Patients
    • physiotherapists
    • physiotherapy
    • protect patients
    • protect the public
    • public
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    • UK
    • whistleblower

Contact the Practice Advisor

Free and anonymous counsel for PTs, patients, & the public. Learn More 

practiceadvice@collegept.org
416-591-3828 ext. 241
1-800-583-5885 ext. 241