As of April 1, 2019, ICBC now allows Acupuncturists in BC to directly bill for treatments provided to patients who have sustained injuries in a motor vehicle accident. Super exciting!
If you’re an Acupuncturist, or a clinic providing Acupuncture services, here’s how you’ll manage your billing for these claims in Jane.
If you’re new to billing Acupuncture services to ICBC, you’ll first want to ensure that you have a Vendor Number.
Create an Insurer
In order to track and manage claims for patients having sustained injuries in a crash occurring on or after April 1, 2019, you’ll need to set up an ICBC insurer. Insurers can be created by heading to Settings > Insurers > New Insurer
You’re going to choose the option Regular Insurance/3rd Party Payer/Lawyer because you won’t be submitting these claims via Teleplan.
You can call it something like “ICBC - Acupuncture”, and set the insurer’s default behaviour. If your fee schedule is higher per visit than what ICBC pays, you may choose to set either a user fee or set the insurer to default patient pays remaining so that the amount of the treatment not covered by ICBC is absorbed by the patient.
You may also find it helpful to include the link to the HCPIR portal in the field for Portal URL
The URL you’ll want to use is https://webapps.icbc.com/ClaimsForms/
You can review this help document for more details on setting up an insurer.
If your clinic is a multi-disciplinary practice, it is recommended that you set up an ICBC insurer for each discipline. So, for example if you offer both Acupuncture and Massage Therapy, you would have one insurer for ICBC - Acupuncture and one for ICBC - Massage. Each discipline does have a preauthorized number of treatments available and for patients seeking treatment with more than one discipline at the same clinic, it will be easier to keep track of the visit counts if each discipline is represented by a separate claim.
Create Custom Billing Codes
ICBC has outlined that there is a specific fee amount associated with a patient’s assessment visit and a separate fee amount for each treatment thereafter.
- Initial Visit & Report: $107
- Subsequent Visits: $90 per treatment
- Number of Preauthorized Treatments: 12
The preauthorized treatments are available within 12 weeks of the date of the accident causing the injury.
ICBC notes that:
“ICBC customers (patients) who choose to visit a health care practitioner that charges a higher rate than what ICBC funds under accident benefits (indicated above), will not be able to recover the user fees from ICBC for claims with a date of loss on or after April 1, 2019. This will mean that the patient is responsible for paying the user fee portion, which they may submit to their private health insurer for consideration of coverage. Treatments are based on sessions provided and fees reflect fair market rate for a standard industry visit. Treatment frequency will be based on clinical recommendations and should reflect best practice. However, multiple sessions provided by the same discipline, on the same day, will not be funded.”
To populate the above fee amounts in a patient’s claim, you’ll want to create custom billing codes for both of the fee items.
Custom billing codes can be created by heading to Settings > Billing Codes > New Billing Code
So like this :
Create a Claim
Once you have the insurer and custom billing codes created, you’re ready to begin building patient claims.
From the appointment pane, choose Add Policy and then Add New Policy.
Choose ICBC - Acupuncture from the list, and then continue to populate information into the claim template.
The only required field is the Claim Identification Number, which will be the patient’s ICBC claim number.
You’ll add the relevant maximums to the optional middle section. This section is where you’ll want to enter Maximum Number of Treatments as being 12 so that Jane will alert you when the amount/value has been reached. ICBC also allows for extensions on coverage if required. The requests for extensions are to be made through ICBC’s HCPIR portal and it is recommended that if you determine an extension is required, you apply for it no later than 2 weeks prior to end date of the patient’s claim. This allows for the claim handler to process the request before the patient’s coverage expires. If coverage has expired and an extension has not yet been approved, you won’t be able to submit further claims until the extension is approved.
Lastly, enter any Default Coverage Amounts that will be populated each time the claim is used - setting defaults can help save time for subsequent appointments that are billed the same each time.
It is recommended that here you enter the billing code that you’ve created to represent the fee amount billed for a subsequent treatment. You will need to override the billing code used on a patient’s first visit to be the billing code that represents the fee amount billed for the initial visit & report, however this step will only need to be done once per patient claim.
For more tips on creating a claim click here.
Insure the Appointment
After saving the claim, you’ll now find the claim attached to the appointment under the “Insurer Info” section on the righthand side of your page.
You do not require a diagnostic code for every billing code. A patient’s diagnosis and any applicable clinical information will now be communicated to ICBC through the HCPIR web-based forms.
To override the billing code from Subsequent Visit to the code for an Assessment Visit, you can use the trash can icon to remove the billing code for Subsequent and then enter the code for an Assessment. This only needs to be done on the patient’s first visit.
If all looks good with the claim, Arrive the appointment. From there, if the patient is due to pay a portion, you can proceed with collecting that payment using the Pay button
Managing the Insurer Invoice
ICBC claims for all disciplines are now managed like any other claim submitted through a portal. How you choose to manage the frequency in which claims are submitted is up to you. You may wish to submit each claim after the treatment has occurred, or you may find that it works better to let claims build up in your Unsubmitted folder and submit a bunch of claims at the same time.
If you prefer to submit each claim as or after the treatment is happening, if you’ve added the link to the HCPIR form to the “Portal URL” field of your ICBC insurer, then you can launch the portal from the Claim Screen.
From the Schedule click on the appointment to open the appointment pane to the right.
At the top of your page, below the patient’s name there is the insurer name in blue.
When you click on the blue words ICBC - Acupuncture you will launch the claim window including a link to the portal where you can submit invoices and any applicable reports:
After submitting the claim to ICBC, mark the invoice as submitted via the drop-down arrow next to the claim:
This updates its state from Unsubmitted to Submitted.
You can also manage your claims from Billing > Unsubmitted.
In the “Unsubmitted” folder, click the drop-down arrow next to an item line to Mark as Submitted, and the claim will move to the “Submitted” folder.
Now you wait for payment.
It is our understanding that payments for ICBC claims will be directly deposited into the bank account used when enrolling for EFT (Electronic Fund Transfer) for your Vendor Number
When you receive confirmation from ICBC that payment has been received, you can record the payments in Jane using the New Payment workflow. If you’re unfamiliar with this workflow, please visit the guide document below.
For the full breakdown of ICBC’s guidelines on invoicing and reporting for Acupuncture, you can visit their website here.
And for some handy videos and guides from ICBC that review how to submit invoices, reports, extensions and discharge notifications through the HCPIR portal click here
You can always email us at firstname.lastname@example.org or give us a call at +1-844-310-5263 if you have further questions, or if you’d like to walk through the setup of this with a member of our team.