The BC Medical Services Plan is a payment system based on trust. You, as the physician, are responsible for what is being submitted to MSP even if your staff or others submit billings on your behalf.
It’s important to remember that even if you were paid, it doesn’t mean that it was billed correctly. Here are a few key points and errors which can help lower your risk of an audit.
Information
- Read both the preamble to the Payment Schedule and fee description
- Be cautious about billing advice from colleagues and private pay companies. Just because your colleagues billed it and were paid for it, doesn’t mean it was done correctly
- Audit tool: review your mini practice profile annually. Do not ignore “flags.”
Records and documentation
- Making and maintaining an adequate record of the service(s) being claimed will support physicians being audited – Refer to Preamble C.10
- You did the work. Ensure you take the time take the time to document in the chart and not just in the billing record (e.g., time based fees)
- Look at your remittances like you do your credit card/bank statement. If something doesn’t look right, contact MSP
- If you receive advice from MSP billing support, document who, what and when
Other
- Ensure you have the correct fee code for the work that you did – don’t try to make a fee code fit the scenario. If no fee code exists for a medical necessary service, you can bill a miscellaneous fee code 00199 (Preamble C. 4 Miscellaneous Services)
- Do not bill for yourself or family members, including immunizations. Refer to Preamble C. 19. 1
Do you have billing questions? To reach our BC Family Doctors Billing Question Service, please click here to submit your inquiry. You can expect a reply from our physician billing experts in less than 7 days.
For more information about Audit and Adjudication, you can visit our Billing Tools page by clicking here.