Billing for benefits and nonbenefits on the same visit

Issue: BCMJ, vol. 57 , No. 5 , June 2015 , Pages 184 Billing Tips

The Billing Integrity Program is seeing a mixing of services—benefits with nonbenefits—appear on audits. Preamble C.1 in the Doctors of BC Guide to Fees states:

“Benefits” under the Act are limited to services which are medically required for the diagnosis and/or treatment of a patient, which are not excluded by legislation or regulation, and which are rendered personally by medical practitioners or by others delegated to perform them in accordance with the Commission’s policies on delegated services.

Services requested or required by a “third party” for other than medical requirements are not insured under MSP. Services such as consultations, laboratory investigations, anesthesiology, surgical assistance, etc., rendered solely in association with other services which are not benefits also are not considered benefits under MSP, except in special circumstances as approved by the Medical Services Commission (e.g., Dental Anaesthesia Policy).

For example, the following scenarios would not be considered benefits:

•    Billing a patient for a cosmetic procedure (not a benefit), but then billing MSP the follow-up visit as an office visit.
•    Ordering laboratory tests in connection with nonbenefits such as periodic company medical examinations or periodic medical examinations in the office where there is no medical issue.
•    Billing MSP for third-party requirements (e.g., billing MSP for a complete examination when the service is a pre-employment examination for a company or organization).

If benefits and nonbenefit services are provided on the same visit, the medical record must clearly reflect a separation. If you are doing a lot of nonbenefit work, it is advisable to keep those visits completely separate and on different days from visits relating to benefits work.
—Keith J. White, MD
Chair, Patterns of Practice Committee


References

This article is the opinion of the Patterns of Practice Committee and has not been peer reviewed by the BCMJ Editorial Board.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 for benefits and nonbenefits on the same visit. BCMJ, Vol. 57, No. 5, June, 2015, Page(s) 184 - Billing Tips.



Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
  • There is no period after the journal name.
  • Page numbers are not abbreviated.


For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org

BCMJ Guidelines for Authors

Leave a Reply