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Posts Tagged ‘HCAI’

FSCO: No Raise for Treating Professionals in 2013

The Financial Services Commission of Ontario (FSCO) has released an updated Professional Services Guideline for 2013.

According to the FSCO website, “The hourly rates are unchanged from the 2012 level. This is in line with the auto insurance rate reduction strategy outlined in the government’s 2013 Spring Budget.”  It has also added a category for kinesiologists, who are now regulated health professionals in Ontario.

A copy of the 2013 Professional Services Guideline is available by clicking here.

Health Care Professionals: Be sure to use new HCAI Forms starting on November 1, 2012

The Financial Services Commission of Ontario (FSCO) has released a new Assessment and Treatment Plan (OCF-18) form, a new Treatment Confirmation Form (OCF-23) and a new Auto Insurance Standard Invoice (OCF-21) for use effective November 1, 2012.  Older versions of these forms will not be allowed as of that date.

You can download these new forms directly from our website by clicking on the links below:

OCF18-2012

OCF21 – 2012

OCF23 – 2012

Anti-Fraud Task Force Steering Committee is Seeking Public Comment

The Ontario Auto Insurance Anti-Fraud Task Force Steering committee is seeking public input on a number of potential recommendations prior to their final report in the fall of 2012.

These recommendations include:

  • Regulation of health clinics
  • Regulation of the towing industry
  • Enhanced authority for FSCO to regulate the business practices of health care treatment and assessment facilities
  • Tightened controls on the delivery of Accident Benefits, including requiring the patient’s signature on invoices before they are submitted, a second Examination under Oath, and billing claimants $500 if the claimant fails to attend an insurer’s examination.  Also being considered is requiring insurers to provide itemized statements to claimants every 60 days
  • Amending the consent provisions of the auto insurance applications to provide greater certainty about the ability to share information for the purpose of detecting and preventing fraud.
  • Provide insurers with broader civil immunity to protect them from lawsuits for reporting suspicious behaviour to regulators and the police
  • A website devoted to informing those injured in motor vehicle accidents about accident benefits and how to detect and report suspicious or inappropriate behaviour
  • Mandatory disclosure by insurance companies to the public about how they select and supervise their preferred providers of services – including independent medical examinations
  • For FSCO to hire appropriate staff and resources to carry-out these recommendations

The entire update can be read by clicking here.

FSCO Releases 2012 Draft Statement of Priorities

The Financial Services Commission of Ontario (FSCO) has released its draft Statement of Priorities for 2012.

Many of the priorities focus on changes to the auto insurance sector.  They include the following:

  • Continuing to assess the extent of auto insurance fraud and consider the recommendations of the task force when their report is released in the Fall of 2012;
  • Exploring ways to utilize the Health Claims for Auto Insurance (HCAI) system to detect and prevent fraud;
  • Implement auto insurance recommendations made in the Auditor General of Ontario’s 2011 Annual Report;
  • Undertake long-term auto insurance reform initiatives, including review of the Minor Injury Group (MIG) protocol and changes to the catastrophic impairment criteria;
  • Reduce the mediation backlog; and
  • Conduct market conduct audit reviews of compliance with the 2010 auto insurance reforms including Statutory Accident Benefits;

The entire draft Statement of Priorities can be read by clicking here.

Toronto Star: Fight fraud, but not at the expense of legitimate claimants

The Toronto Star has published an article about the need to find balance between fighting fradulent accident benefits claims and providing necessary goods and services for legitimaely injured clients.

You can read this article by clicking here.

FSCO Revises HCAI Guidelines

The Financial Services Commission of Ontario (FSCO) has released a bulletin which will revise the guidelines for the Health Claims for Automobile Insurance (HCAI) system, effective December 1, 2011.

These changes include:

  • Health care professionals will only be able to invoice the insurer at the completion of their treatment plan, or once every 30 days if the treatment extends beyond a month;
  • A statement that repeated and/or deliberate submission of duplicate invoices and invoices for non-approved goods and services may be considered by HCAI to constitute a contravention of HCAI’s terms and conditions and result in suspension or revocation of the health care provider’s access to HCAI;
  • A section on recordkeeping has been added to the new Guideline as an extension of Property and Casualty Auto Bulletin A-02/11, Insurer Rights and Responsibilities to Challenge Questionable or Abusive Claims; and
  • Changes have been made to the Appendix 3 Validation Rules in order to provide more clarity for the user.

The bulletin also notes that, effective July 1, 2012, FSCO will issue an amended OCF-21 form that will provide that the “Plan Number” of the OCF-18 or OCF-23 to which the OCF-21
refers is a mandatory field.  This is the unique number generated by the HCAI system when the OCF-18 or OCF-23 to which the OCF-21 refers is submitted, and will enable insurers to properly reconcile invoices.

To read the FSCO Bulletin in full, click here.

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