5 Myths About Direct Billing

I’ve noticed a significant increase in the number of questions being asked by healthcare providers about direct billing. Perhaps this is a consequence of the coronavirus pandemic, and the desire we have to limit our contact as much as possible; or maybe we finally recognize the tremendous value we can offer our clients by direct billing on their behalf. In either case, here are 5 myths about direct billing that I want to dispel.

MYTH 1: You won’t know right away if the claim is covered, so you’ll be left to “hunt down the patient” afterwards if the claim doesn’t go through. 

The truth is that only 3 out of 39 insurance companies in Canada are like this. The rest will tell you immediately how much will be covered. This is called “real-time adjudication” and is a game-changer in regards to direct billing.

MYTH 2: It takes 30 days to be paid from the insurance companies, which leads to cash-flow issues.

I don’t know of a single insurance company that takes that long to pay. Most pay the very next day. Some take a little longer, but the longest wait time is around 2 weeks.

MYTH 3: It’s really easy for your clients to submit their own receipts, so it’s better to just have them do it. Why should you take on the added stress?

This is a big assumption. You may have elderly patients that need assistance with the internet, or some clients who can’t remember their log in details (come on, we’ve all been there). Why would we dump the added stress on our patients? One of our primary goals should be to REDUCE stress … not increase it!

MYTH 4: You can’t trust your patient’s private information to a third party.

All of the insurance portals are PIPEDA compliant.

MYTH 5: If you direct bill, you will be audited more frequently.

CLHIA states: “Assigning benefits does not remove any responsibility from the plan member. The plan member is still responsible to ensure that the submitted claim accurately reflects the services rendered, and it is the patient’s ultimate responsibility to ensure that the healthcare provider is paid in full. Accepting assignment does not increase the possibility that the healthcare provider will be audited by the insurer/benefit administrator. … Audits are typically routine rather than in response to a known or suspected problem.”

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