ICBC has launched some exciting changes for billing Massage Therapy services. The rates per service have been increased and patients who have sustained an injury in a motor vehicle accident on or after April 1, 2019 are now pre-approved for treatment.
If you’re new to billing Massage Therapy services to ICBC, you’ll first want to ensure that you have a Vendor Number. If you’ve previously been billing Massage Therapy claims to ICBC you will continue using your same Vendor Number.
Managing ICBC Massage claims in Jane after April 1st will be very similar to how they’ve been managed previously - the big difference is specifically the amounts billed per treatment - see below under Create Custom Billing Codes for a breakdown of the rates
Create an Insurer
If you’ve been previously billing Massage Therapy claims to ICBC, you can continue to use the same insurer - you may just need to edit the insurer to update the user fee (if applicable) as the new fee schedule is substantially higher than it was before.
If you have not yet begun billing ICBC Massage Therapy claims in Jane, please follow the steps below to set up an 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 - Massage”, and set the insurer’s default behaviour. If your fee schedule is higher per subsequent 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 Physiotherapy and Massage Therapy, you would have one insurer for ICBC - Physio 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
Although ICBC claims will no longer be submitted through Teleplan, ICBC has outlined that there is still a specific fee amount associated with a patient’s initial visit/report and a separate fee amount for each treatment thereafter.
- Initial Visit: $107
- Subsequent Visits: $80 per treatment
- Number of Preauthorized Treatments: 12
For Massage Therapists who are not GST exempt, you will be paid the above amount plus an applicable GST. So for example, on an $80 treatment, you’d receive $84. When you submit these claims through ICBC’s HCPIR portal, you’ll submit for the value as outlined above and once the claim is processed, the amount paid will include the GST.
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 set up the billing code like this if you’re GST exempt:
If you’re not GST exempt, you would need to set your billing codes up to include the GST. Jane handles the tax calculation behind the scenes for you and the value of the billing code must be set inclusive of any applicable taxes.
You will set up the billing code like this if you are not GST exempt:
And for the initial visit, you’d create a similar code with the amount set to $112.35 ($107 plus GST).
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 Claim and then Add New Claim/Policy.
Choose ICBC - Massage 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.
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.
Transitioning Existing ICBC Massage Therapy Claims
To transition your existing Massage Therapy claims, on or after April 1, 2019 you’ll want to edit the existing ICBC - Massage claims to replace the billing code for $24.15 with your new billing code for $80. If you have pre-booked appointments, with their claims attached, you will also need to switch out the billing codes for those treatments from the main schedule under Insurance Info. The number of approved treatments and end date that have been set in the existing claim still apply. For example : if a patient still has 6 remaining treatments available and they occur after April 1, 2019, you’ll simply bill those 6 treatments based on the new fee schedule and submit your invoices through the HCPIR portal.
If services prior to April 1, 2019 still need to be billed and submitted, you will do so using the previous fee per service, $24.15 and the claims will be submitted following the previous ICBC Massage Therapy Guidelines.
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 as 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.
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 - Massage you will launch the claim window including a link to the report:
After submitting the claim to ICBC, mark the invoice as submitted via the drop-down arrow next to its name:
This updates its state from Unsubmitted to Submitted.
You can also manage paper claims from Billing > Unsubmitted.
In the “Unsubmitted” folder, click the drop-down arrow next to an item line to Mark as Submitted, and it’ll subsequently 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)
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 Massage Therapy, 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.