ARP Billing and the 'What if' Game.

We have all played the 'what if' game. "What if I park in the no parking zone, if I'm really quick?"  or "What if I tell this patient that they are never to bring me another Google search again, ever?".  It's all about considering consequence. How does this tie in to Alternative Relationship Plan (ARP) billing you may ask.  Well, let's sit back and discuss this.

I often hear from doctors that ARP billing is easier than Fee For Service billing (FFS).  There is a misconception that ARP is simpler because the claim doesn't get paid per se.  It is assumed that ARP claims are sent to Alberta Health (AH) for tracking purposes... end of process.  This is not fully accurate.  Yes, ARP claims are sent in to AH for tracking, but some of those claims may reject for numerous different reasons, just as the FFS claims do.  These claims need to be correctly altered and resubmitted in order to be accepted by AH.   

Here is where the 'What if" game kicks in.  What if those rejected claims are never dealt with? Is there a real consequence?  Why yes, there is!  AH collects all the data from your ARP billing to determine your Full Time Equivalent (FTE). This means that AH adds up all the claims that have been accepted to determine factors, such as: How many hours of work you have billed and how many services you have provided. Any claims that have not been accepted by AH will not be included in this tally. These results, that AH collects and analyzes from your ARP billing, may cause your salary to come under review.  Be aware that your ARP billing results will directly affect whether you will be granted an extension or additional funding for your program. These are some pretty daunting consequences indeed...

Okay, enough with the doom and gloom. So you have played the 'What if' game and have a bunch of old rejected ARP claims. Now, what can be done? ARP billing follows the same 180 day rule that FFS billing follows. You are able to go back and resubmit any rejected claims that are less than 180 days old.  Whew!  Any claims that are older than 180 days... well you're out of luck. Yes, I still had one last dash of gloom.

Going forward, consider making this whole process much easier. You are able to hand off all of your ARP billing to one of our Medical Billing Professionals and you will never play the 'what if' game again, at least where your ARP billing is concerned.   Our billers will send in your claims and monitor your account to ensure all your claims get accepted. AH will have a comprehensive tally of the work you have provided and you get to reduce your administrative workload. Get in touch if you would like more information.


Shawna Julyan-Gudgeon. CEO and Founder of Alberta Medical Billing