265 wa uninsured services and billing

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265 wa uninsured services and billing

  1. 1. SOCIETY OF GENERAL PRACTITIONERS BILLING FOR UNINSURED SERVICES Dr. Cathy Clelland Executive Director, SGP
  2. 2. Educational materials  Society of General Practitioners of BC www.sgp.bc.ca  BC Medical Association www.bcma.org  MSP Fee Guide and Updates  Uninsured service guidelines  MSP schedule of fees and Resource Manual for Physicians: www.healthservices.gov.bc.ca/msp  Billing questions: info@sgp.bc.ca cclelland@bcma.bc.ca or 2
  3. 3. Overview  What are Uninsured & Third Party Services?  WorkSafe BC Services  ICBC Services  Office of Superintendent of Motor Vehicles Services  Patient or Other Third Party  Making it Work - Individual Fees - Block Fees  The SGP Billing Package 3
  4. 4. What are Third-Party Billing & Uninsured Services?  Services not covered by MSP – Billing appropriately for ICBC or WorkSafeBC and uninsured services will negate any concerns of audit.  Physician bills the responsible party (ICBC, WorkSafeBC insurance company, employer, lawyer, or directly to the patient)
  5. 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. 6. Why FP’s don’t bill appropriately  “Too much hassle”  Don’t know their worth  Fear  Patient Expectations
  7. 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 service
  8. 8. WorkSafeBC  WorkSafeBC should be billed for most work related medical complaints.  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 submitted  Return to Work Consultation (19950 = $260) for contacting Employer to discuss Modified RTW and faxing Form 8 or 11 to Work Safe  New fees for Spinal Cord Injured Patients  Phone and Office Consultations with Work Safe Board Officer, Claims Adjudicator or Physician
  9. 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 WorkSafeBC  Fee Code: 19927 If Faxed form within 37business days
  10. 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 WorkSafeBC:  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. 11. ICBC Billings  All Visits and Procedures billed via Teleplan with MVA indicated  ICBC related visits do not count toward HVLIP calculations  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. 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.  Billings:  Visit 1 – 15300 – ICBC indicated as insurer  Visit 2 – 15300 – ICBC indicated as insurer  Visit 3 – 00278 – ICBC indicated as insurer
  13. 13. Office of Superintendent of Motor Vehicles  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. 14. Office of Superintendent of Motor Vehicles (cont)  Drivers’ Medical Examinations and Forms to be billed 100% to patient (yellow forms):  Drivers’ Medical Certification Forms Patients 80 and Over  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. 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 the patient.
  16. 16. Other Uninsured Services  Sick Notes & Medical Certificates  Insurance Reports  Chart Transfer Fees  Missed Appointments  Travel Advice  Lifestyle Counselling  Cosmetic Procedures  Special Exams – Pilot, Driver’s, Camp, IFA  CPP exam and form  Flu Shots (ineligible)  Medical-Legal Letters and opinions  Income Tax Disability  Telephone Advice / Rx
  17. 17. Billing for Other Uninsured Services  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. 18. Billing for Other Uninsured Services  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 work/school certificates
  19. 19. Other Third Party Billing (Insurance, etc.) Does size matter? Bill appropriately for your time, expertise and liability rather than the size of the form.
  20. 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”  Issues  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  Outsourcing
  21. 21. Remember!  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 patients
  22. 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. 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. 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. 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. 26. Non-insured Billing BCMA fees  #8. Request for cosmetic removal of 4 benign keratoses  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 completion  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 treatment)
  27. 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. 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 your chart  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. 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. 30. Golden Rules of Billing  Be honest  Be accountable  Be able to defend with accurate documentation  Be knowledgeable  Be meticulous  Be effective  Be efficient  Always close the loop
  31. 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. 32. The SGP Uninsured Services Billing Package  SGP Goal to provide value added services - Billing Package - Billing Tips - More to Come…
  33. 33. SGP Package Components  Uninsured Services Posters  Uninsured Services Billing Sheets  Off work Certificates  Support materials
  34. 34. Uninsured Services Posters  2 x 11.5 x 17 exam room posters  1 x 17 x 22 waiting room poster  Bright and colorful  Can be laminated
  35. 35. Billing Sheet  Demonstrates the full value of your services  Powerful Patient Education Tool  Convenient and Easy to Use  The Value of the Discounted / Null Invoice
  36. 36. Off Work Certificate  Size Matters  Enquire whether or not Employer will reimburse  Transfer negative aspect of note to Employer
  37. 37. Make it Easy for your Patients & Staff  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 uninsured services
  38. 38. Effective Billing Requires a “Hands On” Approach
  39. 39. 39 GPSC & Related MSP UPDATE 2010 – PART 2  Questions?
  40. 40. 40 SOCIETY OF GENERAL PRACTITIONERS of BC Thank you, Dr Cathy Clelland Executive Director, SGP

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