FSCO to issue new guidelines intended to protect insurers from getting “papered” by health care treatment plans

The Financial Services Commission of Ontario (FSCO) is releasing new guidelines on Dec. 1, 2011 for Health Claims for Auto Insurance (HCAI) intended to prevent insurers from getting inundated by documentation from health care providers.
The revised guidelines are intended to address complaints received by FSCO from stakeholders regarding practices by some health care providers. Specifically, some of the issues being addressed include:
•Frequency of invoicing. Under the current guideline, health care providers are not restricted in the frequency in which they can submit invoices, which contributes to a high volume of paper for insurers. To address this issue, the new guideline requires that invoices be submitted only once a treatment plan has been completed, or once every 30 calendar days if the treatment extends beyond a month.
•Incomplete/duplicate invoices. To avoid “double-dipping” situations, in which the provider receives payment from both the extended health care benefits carrier and the auto insurer, the new guideline stipulates what information is mandatory on the OCF-21. The guideline will also prohibit duplicate invoices for non-approved goods and services. Repeated and/or deliberate submission of duplicate invoices and invoices for non-approved goods and services may result in the suspension/revocation of the health care provider’s access to HCAI.
•Record keeping. A section on record keeping has been added to the new guideline as an extension of the ‘Insurer Rights and Responsibilities to Challenge Questionable or Abusive Claims.’
The new guideline is available on FSCO’s Web site at www.fsco.gov.on.ca and will be published in a forthcoming edition of The Ontario Gazette.