Auto Insurance Sector Telepractice Billing Enabled Through HCAI

In a memo of April 22, 2020, Insurance Bureau of Canada (IBC) Vice-President, Kim Donaldson, communicated that the industry is endorsing the provision of those services of health professionals that can be appropriately delivered by telepractice to clients who have been injured in motor vehicle accidents.  Telepractice is to be billed at the regular health professional rate as prescribed by the Professional Services Guideline.

In response to advocacy of the Coalition of Health Professional Associations in Ontario Automobile Insurance Services (the Coalition) and its communication of March 27th, Donaldson relayed:

“IBC and HCAI were very pleased to be able to response to the requests from many insurer providers for information on how to signal, for the purposes of HCAI and the claims adjustment process, when telehealth modalities are contemplated and invoiced.”

A communication from HCAI was circulated to HCAI users on April 18th identifying procedures for how health care businesses are to identify services delivered remotely and/or virtually when submitting OCF-18 treatment plans and OCF-21 invoices through HCAI.  Providers are guided to utilize the Attribute Codes that are attributed to telephone based or video based telepractice, noting the "IN" code is appropriate for virtual care provided by a health professional.  View HCAI communique.

Regretfully, at this time, IBC is unable to respond to the variety of other pandemic related issues identified in the Coalition letter of March 27, 2020.

Implications for Occupational Therapists

Occupational therapists working in Ontario’s auto insurance system will wish to observe the guidance that virtual practice will be funded for essential services that can be appropriately delivered by telepractice for claimants injured in motor vehicle accidents.  Billing fees are consistent to the health professional fees outlined in the Professional Services Guideline, 2014.

OTs proposing services to be delivered in a telepractice option on an OCF-18 or billing for such services on an OCF-21 should use the appropriate billing code for the service AND the remote/virtual practice attribute code identified by HCAI.  See HCAI Guidance Document.

HCAI registrants should note that an April 7, 2020 Update Bulletin was sent to all users identifying HCAI system upgrades effective June 1, 2020 and a planned system outage from 5 pm May 29 – 8 am June 1, 2020.