We recently became aware of increased audits of physiotherapy clinics and physiotherapists by Pacific Blue Cross (PBC).
In some cases, these audits have led to demands for repayment of substantial fees previously approved by PBC, even for those who are confident they followed all guidelines appropriately.
On November 27th, PBC released an update which confirms that eligible physiotherapy coverage is:
● ONLY for rehabilitation of an existing medical condition (illness or injury)
● NOT intended for preventative, permanent or ongoing treatment.
● NOT intended for weight loss treatment, to provide an exercise program, or personal training.
Most importantly, PBC defines a physiotherapy visit eligible for reimbursement as one-on-one treatment between the registered physical therapist and the patient.
Any services rendered by other practitioners, such as a physical therapist support worker (PTSW), kinesiologist, personal trainer, or a yoga or pilates instructor during the visit, are not considered eligible expenses for reimbursement, even if conducted under the direction or supervision of a registered physical therapist.
PABC is cautioning all physiotherapists and clinics to review your current PBC billing practices to ensure compliance with the conditions set forth in the November 27th update. This includes ending the use of PTSWs, kinesiologists, personal trainers, yoga or pilates instructors as part of your billing for physiotherapy sessions.
Of course, you may choose to continue to offer these services to patients, but these will not be eligible for coverage by PBC as part of your physiotherapy session billing.
If you wish to continue business as usual, you must bill clients directly for these services and let them know they should not submit invoices directly to PBC or risk receiving an invoice.
We are disappointed with this direction from PBC, and recognize that this will be disruptive for everyone as many clinics will have to realign their business practices and operations. Please know that we are working closely with the BC Association of Kinesiologists, our legal team, and others to develop an advocacy strategy to fight this decision.
We will provide frequent updates on the situation.
For the immediate future, PABC recommends all members carefully review the November 27th update and revise your processes and structure accordingly.
Please carefully review the PBC Update from Monday, November 27th by clicking the button below.