![]() Other practitioners must have documentation to meet the standards or minimum expectations established by their college or as required by Alberta Health. The documentation a physician is required to provide when requested must be consistent with the Patient Record Standards of Practice as established by the College of Physicians & Surgeons of Alberta (CPSA). Physicians and other practitioners are required to have sufficient and appropriate documentation to support the health care services they have identified as being provided in their submitted claims. ![]() concluding and explaining findings and an overpayment amount identified via a Notice of Reassessment.evaluating the physician’s or practitioner’s response.communicating with physicians and other practitioners to inform them about the findings of claim errors or issues via a Notice of Findings, and requesting explanations and further documentation such as patient records, work schedules, and rationale for billing practices.reviewing patient charts, to verify errors or issues.reviewing claims data to identify potential errors or issues.We may conduct interviews of physicians or other practitioners and their staff during these onsite visits. If necessary, we may visit the physician’s or practitioner’s office (announced or unannounced), to obtain additional documentation and electronic records. information from other compliance reviews.news, or media releases from governing bodies.other analytic and monitoring activities, including risk assessments.complaints or tips, either from a member of the public or a colleague.Determining which physician or practitioner to reviewįactors that may inform the Alberta government initiating a compliance review include, but are not limited to: Practitioners are then provided an opportunity to respond to these findings prior to the review’s conclusion. After the review is complete we share interim findings. Compliance reviewĪ compliance review assesses or reassesses submitted claims for compliance, facilitates recovery of incorrectly paid funds, and promotes compliance with the Alberta Health Care Insurance Act, the AHCIP, the Schedule of Benefits such as the Schedule of Medical Benefits, and pertinent legislation.Ī compliance review is an administratively fair process in which the Alberta government notifies a physician or other practitioner of the review and requests pertinent documents. One, or a combination, of these activities may trigger a compliance review, which could identify non-compliance with legislation and lead to the recovery of overpayments. Data analysis, risk assessment methodologies, public tips and complaints are used to identify potential billing errors or issues. To assure accountability and the protection of taxpayers’ dollars, claims submitted to the Alberta government for payment are monitored. Connect with a regulated health profession college.Other practitioners include chiropractors, denturists, dentists, opticians, optometrists or other people who provide basic health services or an extended health service. The act and the AHCIP establish the payment rules for physicians and other practitioners when providing insured health services to Albertans. The Alberta Health Care Insurance Act and its regulations form the governing legislation of the Alberta Health Care Insurance Plan (AHCIP).
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