The Next Phase of AISI

With the vast majority of healthcare providers now using the “auto insurance standard invoice” (AISI) form for billing auto insurers for medical and rehabilitation care given to injured accident victims, the time has come to move forward with the project. At a recent meeting hosted by the Financial Services Commission of Ontario (FSCO), insurers and healthcare providers agreed to simplify some of the data requirements of AISI to avoid duplicative data while still ensuring that insurance adjusters get the information they need to process medical/rehab claims.

The key to streamlining AISI lies in integration of the current “treatment plan” (OCF-18) and the “disability plan” (OCF-5) with the new standard invoice to create a seamless communication between these forms. Everyone agrees that necessary information is listed on the existing treatment and disability plans, but that it also needs to be repeated on the AISI form.

A working group made up of senior representatives from both the insurance and healthcare provider sectors will be meeting over the next few months to map out in detail the integration of the various forms. The working group is expected to issue its final report by the end of the summer, at which time changes to the current AISI form will be recommended. These changes will also relate to the level of detail needed by insurers in identifying the services done by providers. It was agreed that AISI coding should give adjusters the information they need while not being overly difficult for the providers to supply.

Common agreement

What is most encouraging about the latest developments is that there is a common agreement that AISI serves a key purpose in communicating vital information between healthcare providers and insurers. Since Ontario moved to a no-fault auto insurance scheme in 1990, the money spent by insurers on healthcare accident benefits has mushroomed, yet in the past there have been very few means by which to get a handle on these expenses. The issue came to a head when former Justice George Adams, acting as facilitator in fee negotiations between the industry and providers, decried the lack of available data in the reports he tabled in late 2000.

In fact, the idea of a standard invoice has been around for awhile. Over five years ago, when Bill-59 was first being discussed, the industry identified the need for a standard invoice as essential to helping manage the sharply rising cost of accident benefit medical and rehabilitation expenses. These costs have been growing far faster than inflation and healthcare costs within the public healthcare system. Total auto insurance healthcare claims costs rose from $308 million in 1991 – the first full year of Ontario’s no-fault system – to a staggering $1.023 billion by 2000. And, this cost continues to rise at the rate of almost 15% a year.

Clarity needed

Previous billing procedures by healthcare providers in the auto insurance system were simply inadequate, given the magnitude of these costs. In most cases, invoices did not describe the treatments that were provided, nor did they include the name of the provider who performed them. There was no indication of the injury being treated or of the charge for each service provided. Invoices did not show the amount billed to OHIP or to extended healthcare insurers. Most often there was a single charge for the whole bill, with no breakdown for the cost of various services.

The new AISI form is a key instrument in helping the auto insurance industry – one of the largest private-sector payers of healthcare achieve the following wider objectives in the health care sector:

A fair and stable business environment for both health care providers and insurers;

Claimants returning to their pre-accident condition as soon as possible; and

Cost control.

The AISI form incorporates a system of coding for both diagnoses (ICD-10 coding system) and services (CCI coding system) which allows for consistent recording of all medical and rehabilitation claims. The same coding system applies to all healthcare professionals. The Canadian Institute for Health Information (CIHI) recommended these coding systems in a report it did for FSCO in the summer of 2000.

D&P codes

In order to assist health care providers in using these systems, the AISI includes pick lists of both diagnostic and procedural codes which cover the vast majority of injuries and treatments likely to be encountered by injured auto accident victims. These lists were originally drawn up based on the experience of Quebec and other jurisdictions where better medical/rehab data systems were already in place.

These lists are meant to make it more convenient for healthcare providers to select the proper code without having to consult all of the thousands of codes available through these schemes. However, in cases where the pick lists are not adequate to describe the injuries and services at hand, healthcare providers can use any other code found in the ICD-10 and CCI systems.

There is no doubt that many healthcare providers, as well as adjusters, have encountered some difficulty in adapting to the use of long alpha-numeric codes to describe the services rendered. That is why the working group appointed at the recent meeting convened by FSCO will undertake a review of the AISI coding to ensure that the information collected is appropriate for the purpose.

Going electronic

Many of the difficulties related to coding are likely to be overcome once a fully electronic version of AISI is up and running. In an electronic version, long alpha-numeric codes will be replaced with much more readable and convenient drop-down text boxes.

As well, a more complete review of the AISI form will take place in conjunction with the development of a fully electronic invoice system. For now, the official AISI only exists in paper form, although a number of larger clinics have adapted the form to their own practice management software systems. A fully electronic system will allow healthcare providers not only to fill out the form on their computers but to submit the invoice electronically as well, as part of one seamless system.

It is too early to tell exactly when a fully electronic system will be available, but the IBC has already done substantial work in identifying both the key design of such a system, as well as the software vendor best able to develop it. The industry will be working closely with the Workplace Safety and Insurance Board (WSIB) in this effort, as the WSIB is currently in the process of developing a similar electronic invoicing and data collection system for their own medical/rehab claims. By working with the WSIB, the insurers hope to be able to simplify the process by which healthcare providers submit invoices, by offering a common billing interface regardless of the payer.

One of the issues that will have to be addressed once the electronic system is in place is that of access to the data derived from the AISI form. Contrary to the fears of some healthcare providers that the industry would want to keep the data to itself, IBC has proposed that a broadly-based advisory group be put in charge of setting the rules of access to any AISI data. Such a group should include representatives from healthcare provider associations, the industry and FSCO itself and would be responsible for developing a strict access protocol to be adhered to by all parties.

Looking ahead

After six months of use, there is wide agreement that AISI is a vital means of communicating data between insurers and healthcare providers. The joint working group that has been formed to streamline AISI will also review the new form to ensure that the information collected is appropriately detailed for adjusters to make informed decisions. Once up and running, the proposed electronic AISI system will further enhance the effectiveness of insurers in how they handle auto injury treatment claims.