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Beyond the Northern Border: Customized Solutions for International Healthcare Organizations

How CBIZ assists Canadian hospitals with billing American insurance companies through charge capture.

By Rhondelle Tidwell: Medical Coder and Revenue Integrity Consultant

CBIZ KA Consulting Services, LLC (CBIZ) provides services to many facets of the healthcare industry, including assisting our friends across the border in Canada. For those unfamiliar with Canadian healthcare, Canada offers its residents a universal healthcare system.  Although one may be led to believe that healthcare services are totally free for Canadian citizens, the cost to the resident varies by province and is paid through a direct tax (and significant provincial and federal subsidies). Residents of Canada are covered at 100% for most services when they go to the hospital. 

For non-residents, some provinces and territories offer limited free emergency services, but non-residents often will have to pay for specific treatments, or present a form of medical insurance. Visitors to Canada generally receive a basic bill (charge for room and board, basic services).

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Concern:

Canadian healthcare authorities have struggled to recoup non-resident healthcare costs. When the Olympics came to Vancouver in 2010, the main health authority in British Columbia (the province where Vancouver is located) was concerned about the influx of non-residents and how that would impact the bottom line. The authority asked CBIZ for assistance, and we have been providing this service for them for over a decade.

The Importance of Charge Capture:

CBIZ developed a plan to review all bills for non-residents of Canada (NRCs) who had health insurance, to determine if an opportunity existed for additional charge capture. 

Our Solution:

CBIZ receives de-identified copies of medical records for all non-residents that had an inpatient stay. Our project coordinator does a review of each record to add charges for procedures that generally are not included on a bill for non-residents. This process increases the total net revenue that our client hospitals can receive from NRCs for their inpatient stays. 

As part of our service, CBIZ ensures that only patients who have health insurance receive revised bills; patients with no insurance or no means to pay receive a bill at the same rate the Canadian system pays. When the project began, we had pushback from some health authority workers. We explained to these employees that the NRC revenue would help with the overall financial health of the authority, and we were able to get sufficient buy-in. 

Our review services provide millions of dollars a year to British Columbia health authorities, enabling them to capture a significant portion of the cost of care for NRC patients. Overall, our assistance helps defray the cost of services provided to NRCs, which means that more dollars can go to cover the cost of care for Canadians. 

CBIZ provides many customized solutions for our clients, including international coding and billing services. If you would like additional information, please contact us at 609-918-0990.

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