Re: Am I overservicing my patients? Author replies

Issue: BCMJ, Vol. 60, No. 1, January, February 2018, page(s) 12-13 Letters
Lorne Verhulst, MD

The Medical Services Commission (MSC), not the Patterns of Practice Committee, has regulatory authority over the MSC Payment Schedule. If changes to the Payment Schedule are sought (e.g., a new form fee), they must go through the Negotiations Committee. The Medicare Protection Act, Section 17, Subsection 1(b) states: “A person must not charge a beneficiary for materials, consultations, procedures, use of an office, clinic or other place or for any other matters that relate to the rendering of a benefit.” The MSC rationale is twofold: one, the drug prescription is medically necessary; two, completing the Special Authority form is a matter related to the rendering of the benefit.

Also, section C. 5 of the General Preamble to the MSC Payment Schedule states: If it is not medically necessary for a patient to be personally reassessed prior to prescription renewal, specialty referral, release of laboratory results, etc., claims for these services must not be made to MSP regardless of whether or not a medical practitioner chooses to see his/her patients personally or speak with them via the telephone.

So, your discretion is advised. Call the patient in if it is medically necessary. The request by the insurer doesn’t really change things. If the drug you prescribe is medically required and would normally be available to the patient under the Pharmacare program, you must follow the above constraints. The insurer is making sure that Pharmacare is the insurer of first resort.
—Lorne Verhulst, MD
Chair, Patterns of Practice Committee