1. SOCIETY OF GENERAL
PRACTITIONERS
BILLING FOR
UNINSURED SERVICES
Dr. Cathy Clelland
Executive Director, SGP

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. 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. 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. 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
appropriately
 “Too much hassle”
 Don’t know their worth
 Fear
 Patient Expectations

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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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
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. 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
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. 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 honest
 Be accountable
 Be able to defend with accurate documentation
 Be knowledgeable
 Be meticulous
 Be effective
 Be efficient
 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
Billing Package
 SGP Goal to provide
value added services
- Billing Package
- Billing Tips
- More to Come…

33. SGP Package Components
 Uninsured Services
Posters
 Uninsured Services
Billing Sheets
 Off work Certificates
 Support materials

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. 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. Off Work
Certificate
 Size Matters
 Enquire whether or
not Employer will
reimburse
 Transfer negative
aspect of note to
Employer

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. Effective Billing Requires a
“Hands On” Approach

39. 39
GPSC & Related MSP
UPDATE 2010 – PART 2
 Questions?

40. 40
SOCIETY OF GENERAL
PRACTITIONERS
of BC
Thank you,
Dr Cathy Clelland
Executive Director, SGP