Health Benefit Audits on the Rise: Member Clinic asked to pay back $22,000 in claims:

Charting is a Requirement of your Profession

Charting is a requirement of your Standards of Practice and is expected to be done by all professional RMTs nationally.

Yet, we hear from many members that the organizations they work for tell them they do not need to chart. We are unsure where this belief comes from, but please know you need to chart.

Charting improves your skill, your effectiveness, and protects you if you are audited or sued, and allows you to fulfill client requests for their personal healthcare information under the Personal Health Information Act.

Why are there more Audits now?

Historically, RMTs direct billed to insurers using paper submissions that were signed by the client each time. That form and signature was proof that the client attended and was given a treatment.

The introduction of electronic submissions changed this process and insurance benefit providers now use an audit process and specifically chart (SOAP) notes to confirm that a massage therapy treatment occurred and when.

Are Audits just "Witch Hunts"?

NO. Employers across Manitoba spend a lot of money to provide benefits for their employees. Those benefits, like massage therapy, are an extremely important way for employers to ensure they have a safe, healthy and productive workforce.

Each year, insurance benefit providers, like Manitoba Blue Cross, uncover fraud, illegitimate claims, over-charging, and abuse of benefits.

They need to confirm healthcare is being given legitimately, appropriately, and non-fraudulenty on behalf of their clients. Fraud and abuse costs everyone (including you) as it stagnates benefit plan improvements and can even reduce the benefits in a plan as the cost to employers increases when fraud and abuse occur.

Agreements & Audits

Review all of your HEALTHCARE PROVIDER AGREEMENTS and know your responsibilities. e.g. Manitoba Blue Cross requires an extended health benefit form be filled out and signed by your client EACH YEAR. Find out how MANITOBA BLUE CROSS AUDITS WORK and what they expect.