“A member shall only issue a receipt for payments that have been received.”

CCO Standard of Practice S-012 & S-021

Billing and Receipts Overview

According to the Canadian Life and Health Insurance Association (CLHIA), following billing and receipts leading practices will help ensure timely and hassle-free adjudication and payment of claims, while fostering clear and transparent communication between you, your patients and their Extended Health Care (EHC) insurance providers. Following billing and receipts leading practices will also enable you to contribute to prevention and awareness of benefits abuse and Fraud.^[1]

To demonstrate transparency and consistency to insurers, use your invoices to clearly detail the services performed in your clinic, as well as the prices you charged your patient for those services. Include any products or devices your clinic dispensed. Set and adhere to specific prices for various services, products and devices; and provide itemized invoices. This makes it clear to EHC insurers that your fees do not change based on your patients’ benefits plans. This would be a red flag for insurers and could lead to your practice being audited.

Inaccurate, incomplete or inconsistent billing practices result in delayed or declined insurance payments. They may also expose you to improper or illegal activities, such as receipt tampering. As we explore further in the Benefits fraud and Abuse section, suspected involvement, complicity or negligence regarding these issues can have serious personal and professional consequences. They can also cause damage to the reputation of our profession.

Billing and Receipts “Golden Rules” 

1. You should have clear, consistent and detailed fee schedules that are clearly displayed and publicly accessible. For example, having signage in your office and posting accurate and current schedules on practice or clinic websites is a good way to ensure that your patients, EHC insurance provider and the public have access to this information.
2. You and your administrative staff should keep detailed, accurate records of payment, which include the method of payment and the date that payment for services/products was received.
3. In normal circumstances, the amounts displayed on bills and receipts for products and services should correspond to published fee schedules.^[2]
4. A bill or an invoice is a document that is issued to inform your patient of the costs incurred for treatment(s) or service(s). It should indicate whether a balance is paid in full, unpaid, or partially paid with the corresponding dollar amounts clearly displayed. If using direct billing, it is not acceptable to waive any unpaid portion of the claim. 
5. A receipt is a document issued to your patient after you have received payment from them or from the insurer, in the case of direct billing. Receipts or invoices marked “paid” should never be issued until after the payment for the service has been received by you. The date the payment was received should be clearly displayed. If you issue an invoice marked “paid” to your patient prior to receiving payment, EHC insurers consider this to be insurance fraud because it asks the insurer to compensate the patient for funds the patient has not paid.
6. Bills and invoices should not contain blank fields, as this may enable tampering. Such fields should be marked with zeros or N/A as applicable.
7. When care is delivered virtually, receipts and invoices should clearly indicate this
8. Duplicate receipts should always be clearly marked “Duplicate Receipt – Originally Issued on (insert date)”
9. The name of your patient on the invoice should correspond to the name of your patient receiving treatment.
10. Once you provide the service or product, you must sign your name and registration number to the receipt. This is true for fully licensed chiropractors as well as those practising with provisional licenses

Compassionate Care Template

This letter can be used when you offer discounts to a patient for compassionate reasons. You should include it in your patient’s file as documentation.

[Clinic/Practitioner Letterhead]
[Date]

I, [insert patient’s name], hereby acknowledge that for compassionate reasons, [insert your name] has agreed to reduce my fees for treatment. The cost of the treatment per visit will be $ [insert amount].

This reduced fee for treatment will begin on [Insert date], and this agreement will be valid for [length of time]. After that time, this agreement will be re-evaluated by me and [insert your name].

I, [insert patient’s name], agree that the terms of this agreement are subject to my observance of the normal policies and procedures of [insert your name and clinic].

Comments:

_____________________________________
Patient Signature and Date

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Treating Chiropractor Signature and Date