Good Practice: Transparency of Fee Schedules

  •   March 4, 2021
  •  Nancy Littke, PT

Physiotherapy Alberta often receives queries from the public, third-party payers or physiotherapists regarding fees for physiotherapy services. These queries fall into two main categories: requests for a copy of a fee schedule for physiotherapy services, or questions regarding the appropriateness of fees charged by physiotherapists. Payers and clients also contact Physiotherapy Alberta to express concerns when they receive a bill at the end of treatment that is unexpected and/or different than what they were prepared for.

Physiotherapy Alberta does not provide a fee schedule for the provision of physiotherapy services. Setting of fees is a business decision that must be made by the practice owner based on the business model, services provided, costs to provide the services, and the market in which the services are offered.

Physiotherapy Alberta’s jurisdiction is to regulate registered physiotherapists. To that end, the College has developed Standards of Practice that inform physiotherapists of the expectations, obligations, and requirements of their professional role. As members of a self-regulated profession, physiotherapists are required to be aware of the Standards and to ensure their practice meets these expectations regardless of their practice site or employment relationship with the business owner.

The Fees and Billing Standard identifies two performance expectations related to the setting of fees and fee schedules.1 The physiotherapist is expected to:

  • Clearly communicate applicable fees to clients and payors prior to the provision of physiotherapy services.
  • Provide a fee schedule that includes transparent and accurate information about billing policies and all potential charges (e.g., assessments, reports, cancellations, equipment, any additional specialized fees, interest charges).

So, what does this mean in practice?

The first statement identifies the requirement that clients must have easy access to the clinic or clinician’s fee schedule before appointments are booked or services are provided. Clients have the reasonable expectation that fee schedules are transparent, justifiable, and clearly communicated. They also have a right to this information before making an appointment to enable them to make an informed decision about their physiotherapy care.

The client should be able to easily access the fee schedule on a provider’s website. They should not have to perform a deep dive into the website content to find it. It is not acceptable for the client go through the entire booking process before the fee for service is identified. If the physiotherapist or physiotherapy business does not have a website, they must provide other opportunities for prospective clients to determine what fees would be applicable should they choose to seek care. This could include posting the fee schedule at the clinic or including this information as standard, consistent communication provided to individuals who call seeking clinic information or to book an appointment.

What do you mean by “transparency of all potential charges”?

The second statement outlines the expectation that the clinic or clinicians fee schedule is transparent and clearly provides information related to all charges that may be applied. Transparency means there should be no surprises. Often fee information, when it can be accessed, only identifies fees for assessment or treatment sessions. This excludes information about fees applied when specific interventions are provided or discounts for specific populations (seniors, first responders etc.). While both are permitted under the standard, the client must also be informed of these potential fees and how or when they would be applied.  

A client should not be surprised by an unexpected fee applied after the fact. Complaints about unexpected fees are often related to unexpected interest charges on unpaid account balances, cancellation fees for missed or canceled appointments, and added costs for use of a specific modalities or treatment interventions.

Fees for chart copies

The final set of fees often excluded from a clinic’s fee schedule are costs associated with providing a copy of the client’s health record or a report for a third-party. The Personal Information Protection Act (PIPA), which applies to most records held in private practice environments, allows for a fee to be charged for providing a chart copy but does not provide a guideline of what is a reasonable fee.2 However, the Health Information Act (HIA) has prescribed fees.3 Physiotherapy Alberta recommends that physiotherapists refer to the HIA fee guidelines as a starting point for setting clinic fees for chart copies provided under PIPA.

It is not acceptable for the fees charged to create a barrier to the person’s access to their own health information, nor is it acceptable for the fees to serve as a source of profit for the clinic. Fees should represent the actual costs of preparing a copy.2 These costs could include:

  • The time and cost required to retrieve the record.
  • The cost of copying the record.
  • The cost to deliver the record, if applicable.

If a fee will be charged, the organization must give the applicant a written estimate of the total fee before providing the service.2 The applicant should agree to the amount before the request is processed. The organization is permitted to require a deposit prior to processing the request.2 It is expected that these fees be clearly identified on the clinic’s fee schedule.

To summarize

  1. Regulated physiotherapists must develop a fee schedule.
  2. The fee schedule must be transparent and include all potential charges.
  3. Clients must have easy access to the complete fee schedule prior to the scheduling and/or provision of any physiotherapy services.

  1. Physiotherapy Alberta College + Association (2017) Standards of Practice: Fees and Billing. Available at https://www.physiotherapyalberta.ca/files/practice_standard_fees_and_billing.pdf
  2. Government of Alberta (2014) Personal Information Protection Act. Alberta Queen’s Printer. Available at http://www.qp.alberta/documents/Acts/P06P5.pdf.
  3. Government of Alberta (2020) Health Information Act. Alberta Queen’s Printer. Available at https://www.qp.alberta.ca/documents/Acts/H05.pdf