2. Educational materials
Society of General Practitioners of BC
BC Medical Association www.bcma.org
MSP Fee Guide and Updates
Uninsured service guidelines
MSP schedule of fees and Resource Manual for
Billing questions: email@example.com
What are Uninsured & Third Party Services?
WorkSafe BC Services
Office of Superintendent of Motor Vehicles Services
Patient or Other Third Party
Making it Work - Individual Fees
- Block Fees
The SGP Billing Package
4. What are Third-Party Billing &
Services not covered by MSP – Billing
appropriately for ICBC or WorkSafeBC and
uninsured services will negate any concerns of
Physician bills the responsible party (ICBC,
WorkSafeBC insurance company, employer,
lawyer, or directly to the patient)
5. Why is it important?
Unprecedented Public Awareness of
challenges in Family Practice
Critical that services that are not the
responsibility of MSP are not billed to MSP
Critical that patients be educated
Critical that physicians be revitalized and
refocus the value of their services
Critical that we demonstrate value in Family
Practice to graduating physicians
6. Why FP’s don’t bill
“Too much hassle”
Don’t know their worth
7. Billing WorkSafeBC
Verify if work related problem or if injury
occurred at work
Verify if patient is covered
Bill WorkSafeBC via teleplan for
professional service and form completion
It is fraudulent to knowingly bill MSP for a
WorkSafeBC should be billed for most work related medical
Work Safe BC (previously WCB) pays all services at 8%
premium on MSP rates
Form Fees for First visit (Form 8) and follow up visits (Form 11)
billed in addition to visit fee – higher value if electronic forms
Return to Work Consultation (19950 = $260) for contacting
Employer to discuss Modified RTW and faxing Form 8 or 11 to
New fees for Spinal Cord Injured Patients
Phone and Office Consultations with Work Safe Board Officer,
Claims Adjudicator or Physician
9. WorkSafeBC Billing Examples
#1a. You evaluate a 33 year old typist with history and signs of
lateral epicondylitis from RSI. You prescribe NSAIDS and
Physiotherapy and off work for 2 weeks:
Visit Fee Code: 00100 Dx. Code: 781
Physician’s first report Form 8
Fee Code: 19937 If Electronic form within 3 business days
19900 If Faxed form within 3 business days
19938 If Electronic form if 4 - 6 business days
19901 If Faxed form if 4 - 6 business days
If form 8 not initially required as she did not miss any work (only
bill 00100 to WorkSafeBC), but subsequently requested by
Fee Code: 19927 If Faxed form within 37business days
10. WorkSafeBC Billing Examples
#1b. Follow-up visit in 2 weeks shows some improvement,
but after re-examination you discuss with patient concerns
about her return to full time full duties. You then contact her
employer who agrees to a graduated return to work to allow
her to continue physio, over the first 4 weeks. You then
submit this RTW plan on a form 11 (follow up form) to
Fee Code: 19950 Dx Code: 781
19950 Graduated RTW fee is an inclusive fee for the
assessment, plan and form and is valued at $260.00.
11. ICBC Billings
All Visits and Procedures billed via Teleplan with MVA
ICBC related visits do not count toward HVLIP
All Medical Legal and Forms billed directly to ICBC
A00278CL19 Medical Report & Physical Exam—$144.13 +
$32.14 bonus (if submitted within 15 days of request)
A00098 ICBC Consult (meeting or telephone call)—$51.34 (per
15 minutes or portion thereof)
12. ICBC Billing Example
#2. Mr. B 52, comes in to see you the day after he was rear
ended at an intersection. He complains of stiff neck, no
neurologic findings, but local soft tissue injuries. You
prescribe Naprosyn and refer him to PT. You see him again 2
weeks later and find he is improving and advise he continue
with the same program. After 10 sessions the PT reports that
he is ready for a graduated return to work. At the same time,
you receive a CL19 form to complete for ICBC. You arrange for
him to come in 3 days later and complete the examination and
form for the CL19.
Visit 1 – 15300 – ICBC indicated as insurer
Visit 2 – 15300 – ICBC indicated as insurer
Visit 3 – 00278 – ICBC indicated as insurer
13. Office of Superintendent of Motor
Drivers Medical Forms paid in part by OSMV –
When completing these blue forms, the
examining physician has the ability to choose to
bill the patient the entire BCMA recommended
rate* or to bill OSMV via teleplan and balance bill
the patient the difference
Patients with Disabilities &/or Diabetes
96220 Driver’s Medical Examination Report – DMER ($75.00)
96221 Diabetic Driver Report – stand alone ($75.00)
96222 Diabetic Driver Report plus DMER ($105.00)
Office visit for unrelated condition billable to MSP
14. Office of Superintendent of Motor
Drivers’ Medical Examinations and Forms to be
billed 100% to patient (yellow forms):
Drivers’ Medical Certification Forms Patients 80 and
Professional Drivers (Class 1, 2 & 3)
Applicable Uninsured Services Fee Codes:
*A00056 Driver's License - limited exam.
*A00055 Driver's License - full exam.
* BCMA rates are a guideline only – see rates updated April 1
annually. Physician to determine actual rate charged.
15. Non-insured Billing OMSV fees
#3. 52 yr old diabetic professional driver seen for
complete OSMV examination and blue form
completion (both DMER and Diabetic Driver Report):
Fee Code: 96222 Dx Code: 250
Balance bill to patient if you wish the difference between your
rate and the $105 that is paid by OSMV.
If this patient also had an acute illness – eg. Sinusitis,
then bill MSP 15300 Dx code 461 in addition
If this patient was not diabetic and presented with a
yellow Drivers Medical Exam – must bill the entire fee to
16. Other Uninsured Services
Sick Notes & Medical
Chart Transfer Fees
Special Exams – Pilot,
Driver’s, Camp, IFA
CPP exam and form
Flu Shots (ineligible)
Medical-Legal Letters and
Income Tax Disability
Telephone Advice / Rx
17. Billing for Other
Be proactive - start from day one!
Inform patients of their responsibility for payment prior to
the delivery of the service
Ensure visible information in waiting and exam rooms
outline uninsured services
Tools to Assist with Uninsured Services Billings
SGP Uninsured Services Billing Package for SGP members
Check with your bank for VISA, Master Card, Debit processing.
Cash and Cheques may be an option but set up an NSF cheque
policy and make sure the fee for returned cheques is visible
18. Billing for Other
Always use discretion and be considerate
Be aware of individual patients ability to pay
BCMA recommended fee schedule = guideline for uninsured
service fees – 2010 on web now – Updated April 1 annually
Don’t feel guilty for billing appropriately for uninsured services
Issuing “no charge” invoices is educational
SGP Uninsured Services Billing Posters available for
download from members’ side of website.
Sign up for access to printed pads of invoices and off
19. Other Third Party Billing
Does size matter?
Bill appropriately for your
time, expertise and liability
rather than the size of the form.
20. Block Fees
Objective – pre-payment of specific set of uninsured
services or for access to “reduced rates” for these
services rather than “pay as you go”
Optional to all patients
Establish individual and family rates
What will you include in the “basket”
Can you exclude some patients
Dealing with confrontation
Accounting and collection
Billing appropriately for 1 sick note at $15 for
every office day generates ~ $3,540 / year...
office medical supplies cost < $2,500 per year
for a full time equivalent GP
Can you afford not to bill for these services?
If you undervalue your services, so will your
22. Non-insured Billing
Canada Pension Plan - CPP
#4. You reassess a 56 year old with severe RA who
is also applying for CPP brings in forms. You later
spend 40 minutes preparing a 2 page medical
summary. What do you bill CPP?
Visit fee Code: 00100 at BCMA rates not MSP rates
Form / report completion Fee Code: A00059
Note that CPP will only pay you $65 for the form and
report. You have to decide if you will balance bill the
patient. N.B. use discretion
23. Non-insured Billing BCMA fees
# 5. 33 year old assessed with tonsillitis, treated
with appropriate prescription & then requests sick
note for 2 days:
Fee Code: 00100 to MSP Dx. Code: 463
Form fee Code: A00060 – BCMA recommended rates
revised April 1 annually.
24. Non-insured Billing BCMA fees
#6. A 24 year old patient presents with a non-
plantar wart (eg. Common wart on hand) and
requests liquid nitrogen be applied:
Can you bill MSP for this? No
What should you bill?
BCMA Rate for fee code: 00190
Plus BCMA Rate for fee code: 00044 (tray fee)
What if the patient was 10 years old? MSP will cover non
planter warts in children under 16 years of age.
25. Non-insured Billing BCMA fees
#7. A patient has seen you before and decides to
return for the elective removal of an obviously benign
and asymptomatic sebaceous cyst.
Is this an insured service?
No – this is considered an uninsured service and the patient must
be billed directly. Use BCMA rate for 13620 fee code plus major
tray fee 00090 as a basis for setting your fee.
If the sebaceous cyst was inflamed (ie. Medical reason for
excision) then the service would be insured.
26. Non-insured Billing BCMA fees
#8. Request for cosmetic removal of 4 benign
BCMA Rate for fee code: 13620 plus 3 X 13621
Plus BCMA Rate for fee code: 00090 (tray fee)
#9. 14 year old seen for camp physical with form
BCMA Fee Code: A00068 billed to patient as this is an
uninsured service, unless there is something completely
unrelated that would be billable to MSP (eg. Plantar wart
27. Non-insured billing
#10. Healthy 22 year old requests flu shot in
province where not covered
BCMA Rate for fee code: 00010
Plus cost of serum
#11. Request for travel advice and Hepatitis A shot
which patient buys
BCMA Rate for Fee code: 00100 if < 20 minutes or 00120 if >
30 minutes – billed to patient as travel advice is not considered
medically necessary and is therefore uninsured.
28. Medical Legal Reports
#12. You dedicate 1.5 hours for chart review,
medical legal report dictation and review. You
include copies of 20 pages of relevant records from
Fee Code for medical legal report: A00072
Plus Fee Code: A00095 per 15 minutes for chart review
and Fee Code: A00096 per page for Photocopies
Note – BCMA rates are guidelines only, if you feel the rate
does not reflect the time spent on preparing the report, you
are free to determine your rate based on an hourly rate
that you feel is appropriate. (eg. 5 X 00100 at BCMA Rate
is a reasonable hourly rate = ~$300.00 per hour)
29. Insurance Reports
#13. What will you charge the insurance company
for completing their request for the “Attending
Physician’s Statement of Health”
BCMA Fee Code: A00069 of short form
BCMA Fee Code: A00059 if long form
BCMA Fee Code: A00070 if typed short letter
BCMA Fee Code: A00071 if typed long letter
30. Golden Rules of Billing
Be able to defend with accurate documentation
Always close the loop
31. Never Forget To!!!
Stay up-to-date with the fee schedule
Complete all components of the bill!
Always verify who is the responsible party!
Bill for daily minor procedures
Bill WorkSafeBC or ICBC whenever appropriate
Never bill the MSP for uninsured services
Bill for uninsured services when appropriate
32. The SGP Uninsured Services
SGP Goal to provide
value added services
- Billing Package
- Billing Tips
- More to Come…
33. SGP Package Components
Off work Certificates
37. Make it Easy for your Patients
Ensure awareness by having staff ask if there
are any forms to complete or notes required and
point out “uninsured policy” before visit
Give invoice to patient before leave and before
form/note completed – copy on chart, payment
upon pick up of form/note
Offer Credit Card / Debit Card Acceptance
Optional Annual Billing for Block Fees for
10 - 15 % of a physicians gross billings can be generated by discretionary billing for uninsured services.
Historically, physicians have been very poor at billing for uninsured services due to an discomfort of giving the patient a “bill”.
Physicians can no longer afford to ignore billing for these services.
This is a time of renewal in Family Practice. We have a new agreement and perhaps a new relationship with government. We have taken some initial steps towards financial recognition of physicians who are providing longitudinal patient care. There is growing public awareness of the problems in Family Practice and the shortage of Family doctors in this province. There is growing understanding in public and government spheres of the pivotal role Family Physicians play in Primary Care. There is heightened public awareness of the value of having a Family Physician. “Private Medicine” is in the headlines almost every day, and patients know that change is in the wind. Opportunity could never be better for introducing change into the way we handle Uninsured Services with our patients. We need to educate our patients that not everything we do is covered by the Medical Services Plan. We need to embrace and publicize our ability to perform Uninsured Services, as they are one of the few services that pay at a rate reflecting our true worth. It is time for a shift in thinking; for transforming that half empty glass to half full; for embracing Uninsured Services as a means of enhancing our practice income and practice satisfaction. By educating ourselves and our patients as to our worth, we take an initial step towards revitalization of our profession. The survival of quality longitudinal care family medicine is dependant upon us demonstrating professional pride and passion to the physicians of tomorrow.
Many GP’s find that the hassle of invoicing isn’t worth the bother. Their offices may not be set up efficiently to deal with non MSP payments. Often it is too much trouble to look up fees. Physician morale is at an all time low and many GP’s don’t have any idea what their signiature is worth in terms of expertise and medical legal liability. Many physicians don’t have a firm idea of what their time is worth. In taking the initiative towards billing appropriately for Uninsured Services, a good first step is deciding on an absolute minimum that any signiature is worth, no matter how trivial the task. Secondly, decide what your time is worth per 10 minutes and use this as a billing quide when doing paperwork. Don’t be afraid to monitor how long you spend on each form; lawyers do it, why shouldn’t we? Many physicians have a fear of “compromizing” the doctor-patient relationship by asking for money. Nothing could be further from the truth. Patients talk to one another. They know that forms cost money. They know what doctor X down the street is charging for his Driver’s Physicals. They expect to be charged. Don’t disappoint them! Many physicians used to fear losing the patient to another practitioner… This is no longer reality. Our patients are aware that they are lucky to be amongst those that can say that they have a family physician. They are increasingly aware that their relationship with us has value, and are accepting of the fact that new costs and patient payments are creeping into the Family Practice landscape. The longstanding perception under MSP that “everything in medicine is for free” is finally eroding. The timing never could be better for educating patients about our worth and charging appropriately for Uninsured Services.
Edit to provincial specifics
Short vs Long Insurance Form. Cosmetics including cryotherapy for non plantar warts. Remember the do’s and don’ts of Uninsured Services – proper invoicing, inform in advance of fee, use discretion.
The patient must always be informed in advance that the service they have requested is not covered by the HCP. They should be advised of the fee in advance. Payment upon completion of the service is an appropriate expectation of the physician.
The use of patient information sheets will educate patients of your office policies. Well trained staff can proactively infirm patients when they request services that are un-insured thus preventing patient discontent and arguments. Uninsured service fee schedules should be posted in the waiting room and exam rooms.
Always use discretion and be aware of individuals ability to pay. Reducing rates or issuing no charge invoices can be very effective. Educating patients that you have reduced or decided to not charge them for a un-insured service should always be done in a manner so that they do not “loose face”
Many patient complaints received by provincial regulatory colleges are a consequence of poor communication between the doctor and the patient. This holds true especially when it applies to the billing of uninsured services. Many patients assume that ALL services are covered. It is therefore very important to proactively educate the patient.
Finally - don’t leave the “dirty work” to your staff. The physician should take ownership for all office policies and personally deal with patients who challenge staff about the billing of uninsured services.
Block fees are in effect an insurance premium that the physician annually offers to their patients to cover a basket of un-insured services instead of paying for each service as they incur it.
Issues to consider are:
What services will you include in the basket?
Will you offer different plans such as a basic plan or a premium plan that offer coverage for more services?
You can’t oblige patients to enroll
As with any insurer you don’t have to offer this insurance to all patients especially heavy users
Administrating block fees requires ongoing monitoring of who is enrolled, who has paid, individual renewal dates etc.
You want avoid issuing a bill to a patient who is insured
Companies are offering ability for docs to outsource this to hopefully reduce staff work
The CMA’s Practice Solutions is now offering such a service with the assurance that their program will meet all of the strict ethical codes of the CMA
This slide is a case example of the value of billing for non-insured services
Q15b - In BC, wart treatment is only covered if the wart is plantar or genital. All other warts are not covered and the procedure must be billed directly to the patient. If a special visit is arranged solely for the wart treatment then the office visit must also be billed to the patient.
The same applies to benign mole, papilloma or sebaceous cyst removals. It is important to review the fee schedule and all HCP update memos to stay abreast of the increasing number of procedures that are being de-listed.
The provincial medical association will publish recommended fees for non-insured services as well as non-insured procedures. In general - the provincial medical association fee schedule is used.
The removal of a benign, asymptomatic sebaceous cyst is deemed, by most provinces, as cosmetic and is thus, not covered.
It is appropriate to bill for your service fee using either the provincial fee code or your medical association recommended fee.
Always advise the patient in advance that they are responsible for the payment of the procedure.
It is recommended that you contact the lawyer is provide an estimate for what your service charge will be. They will most likely approve your estimate. You can request payment on completion of the report..
The above rules are essential.
Bottom Line : Close the loop
You will only be paid for what you do is you know you can be paid for it, you bill for it, you verify you get paid for it. Close the loop
Above all – be honest and accountable.
The Future – IT / EMR Primer?... Recapturing the easy visit?... Others…?
Backdrop this slide – Photo of the package components
Don’t be afraid to have a VISA sign on the window. It reminds the patients that not everything in medicine is for free.