Sent on behalf of Daniel Kirkpatrick, Client Support Manager, Doctors Technology Office
FOR THE INFORMATION OF: PSP Regional Support team’s and DoBC Regional Advisor & Advocate team
FOR INTERNAL USE – DO NOT FORWARD
We have been working over the last few months on the TELUS Health (Med Access EMR) billing issues impacting clinics. Here is the outcome:
- This issue impacted Med Access EMR users only.
- This involved claims being submitted for payment but are stuck “in limbo” meaning the claims are not rejected (ie. no error message received) but remain sitting there with the status of “submitted”.
- After active engagement TELUS Health (Med Access) did send a message out to all BC users (see bottom of email) providing a reminder about billing reconciliation.
- TELUS Health has confirmed that they did identify the root cause and have made changes to the way in which they connect with MSP and hand over the claim (ie. if they do not get an “accepted” response back from the MSP, the bill will not move in to submitted status).
- They found two scenarios with some claims stuck in pending that were actually paid (but linked up to incorrect claims) and some that were just stuck “in limbo".
- Feedback from clinics that we have spoken and the Vendor were that many claims were resubmitted by clinics and paid. Some claims had to be appealed and most (if not all) were paid if they fell within the 18 month appeal period.
- Unfortunately, we are not aware of any clinics that had appealed to MSP for periods longer than 18 months who were successful. We do not believe that we have any ability for Doctors of BC to change/impact this.
- The clinic/vendor contract we reviewed (albeit this was a recent clinic contract) had very specific language explicitly outlining the clinic’s requirement to be checking/auditing the status of claims.
5.4 Billing. The Client acknowledges and agrees that some government entities and other entities who reimburse for medical expenses impose cut-off times and timelines for submissions of electronic bills for medical procedures. Client acknowledges and agrees that it is Client’s responsibility to process electronic medical bills using the EMR Services in a timely manner and that TELUS has no control over Client’s diligence in this matter. Any alert system or notification for stale or expired bills in the EMR Services is provided to the Client solely for its convenience and should not be considered as a replacement for rigorous accounting practices. The Client should perform regular receivable accounts reconciliations to confirm that all medical bills have been properly submitted and paid. Without limiting the generality of Section 5.2, TELUS shall not be liable for lost revenues caused by bills submitted after the cut-off times or timelines even if such failure is caused,
- Best practice does dictate that clinics are checking claims on a regular basis to ensure that any issues are identified. We do acknowledge that many clinics/physicians had put a lot of faith in their EMR product to provide that function and weren’t doing that in their workflow. Many clinics are doing this now on a regular basis.
If you are contacted by any TELUS Health (Med Access) clinic that believes they are affected or might be impacted then:
1. Have them check their submitted claims to look for outstanding items that have been there for some time.
2. If they identify that there are outstanding submitted claims then please have them raise a ticket with the TELUS Health (Med Access) support desk and document the ticket number.
3. If they are not sure how to check please encourage them to contact the TELUS Health (Med Access) support desk for additional support on how to check.
4. Encourage them to be checking claims on a regular basis and query any unusual or outstanding claims with the relevant stakeholders (ie MSP, EMR Vendor).
If you have any questions please contact me firstname.lastname@example.org on 604-638-2944.