Stepping up educational efforts under the new PMA

Issue: BCMJ, vol. 58 , No. 2 , March 2016 , Pages 104 Billing Tips

Over the past 2 years the Patterns of Practice Committee (POPC) stepped up its educational efforts by writing articles for the BCMJ to address important topics such as billing by locums, the audit process, tray fees, and billing for family members. The POPC also met with several sections to discuss billing trends identified in recent audits. Starting this year the committee is undertaking new educational activities to help ensure you are being paid appropriately for the work you do and to help you avoid billing problems that could result in an audit.

In the year ahead the POPC will enhance the practice mini-profiles, continue submitting articles to the BCMJ, and carry out educational campaigns focused on priority areas. All activities will be driven by data and evidence and will ensure a fair approach and process for all physicians. The POPC’s increased educational activities align with the committee’s obligation under the 2014 Physician Master Agreement to support the goal of high-quality patient care and effective utilization of physician services.

Starting this year physicians will also receive individual letters identifying fee codes for which their billing patterns are significantly outside the mean (i.e., 3 to 4 standard deviations or higher). The letters will outline where a physician stands in comparison to their peers and rank in terms of billings for those fee codes. This will provide an opportunity for physicians to consider whether their billings can be appropriately justified or whether they should make changes to their billing pattern. The letters will also provide detailed information and examples about how to bill the fee codes in question. As always, physicians will have the opportunity to discuss any concerns they have with the appropriate Doctors of BC staff member on a confidential basis. 

If you receive a letter from the POPC about your billing pattern, we suggest that you do the following:
1.    Review your use of the fees in question and the guidelines for the use of the fee codes as outlined in the MSC Payment Schedule and Preamble. 
2.    If you have any questions regarding the proper use of a fee code, contact Ms Lea Harth at Doctors of BC (lharth@doctorsofbc.ca) for clarification.
3.    If needed, adjust your billing pattern to help avoid issues that could trigger an audit. 

Occasionally, the Billing Integrity Program (BIP) at the Ministry of Health also sends out educational letters, as well as performing audits. If you receive a letter from the BIP we strongly encourage you to take the opportunity to adjust your billing practice. 

Finally, be sure to review your practice mini-profile, which can be found in the My Account section of the Doctors of BC website. Other useful tips can be found in the Billing and Audits section of the Resource Centre at www.doctorsofbc.ca.
—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. Stepping up educational efforts under the new PMA. BCMJ, Vol. 58, No. 2, March, 2016, Page(s) 104 - Billing Tips.



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