Billing and audit: Avoiding the pitfalls

Issue: BCMJ, vol. 58 , No. 6 , July August 2016 , Pages 330 Billing Tips

I am frequently asked by physicians, “What could get me audited?” There is no simple answer.

In any system that pays for services, there is an audit process. Approximately 103 million claims are processed each year by Health Insurance BC. The system allows physicians to submit billings in most cases without pre-approval. The system is built on trust and is designed to pay. As a result, physicians may continue to bill incorrectly for many years, and it is not until they are audited that they become aware of a problem.

By heeding the following advice you may reduce the chances of triggering an audit and also reduce the chances of a bad outcome if you are audited:

  • Don’t rely on MSP to tell you that you did not bill something correctly. Just because you billed for it and were paid does not mean that you billed correctly.
  • Take the time to document what you do.
  • You or the office you are working in must bill your services under your practitioner number for locum work.
  • Read the Preamble and your section of the Doctors of BC Guide to Fees.
  • Be cautious about following billing advice from well-intentioned colleagues.
  • Look at your Practice Mini-Profile, and do not ignore flags.
  • Don’t get creative with the fee schedule.
  • Do not bill for yourself or family members.
  • Avoid ordering unnecessary lab tests.
  • Look at your remittances. If something doesn’t look right, phone MSP.
  • Do not ignore a letter from the Billing Integrity Program.
  • If you get advice from MSP billing support, document whom you spoke with, when, and what you were told.

You are accountable for what is billed under your MSP billing number. Passing the blame will not help you if you are audited.
—Keith J. White, MD
Chair, Patterns of Practice Committee

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This article is the opinion of the Patterns of Practice Committee and has not been peer reviewed by the BCMJ Editorial Board. For further information contact Juanita Grant, audit and billing advisor, Physician and External Affairs, at 604 638-2829 or jgrant@doctorsofbc.ca.

Keith J. White, MD. Billing and audit: Avoiding the pitfalls. BCMJ, Vol. 58, No. 6, July, August, 2016, Page(s) 330 - Billing Tips.



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