Thinking of retiring?

Issue: BCMJ, vol. 59 , No. 2 , March 2017 , Pages 126 Billing Tips

Transitioning away from full-time practice and planning for retirement can be a very exciting time in a physician’s life.


Transitioning away from full-time practice and planning for retirement can be a very exciting time in a physician’s life. However, receiving an audit notice from the Billing Integrity Program could change or delay those retirement plans. Therefore, the Patterns of Practice Committee is committed to educating physicians who may be planning or nearing retirement.

Recent audits and trends reveal that physicians who are nearing retirement are billing for fee items 14033 (annual complex care management fee) and 14075 (attachment complex care management fee) just prior to their retirement. Both fees are payable once per calendar year, per patient, on the date of the complex care planning visit. While the retiring physician may have completed the care plan, there is another element to the complex care fees: the longitudinal care of the patient for that year. The billing requirements for these complex care plan fees are not met if the retiring physician is not intending to provide longitudinal care. Incorrect billing may also impact the physician who is taking over the care of these patients.

Retiring physicians should ensure that they are providing all of the services required by the fee items they are billing. Additionally, from a collegial perspective, we suggest that the retiring physician should intend to provide longitudinal care for at least the greater portion of the year (i.e., 6 months or more). Ideally, this would be discussed between the retiring physician and the physician taking over the care of these patients to ensure appropriate continuity or transfer of care. Note that even after a physician retires, fee-for-service billings can still be audited. Records, therefore, need to be accessible after retirement.

For further information, refer to the College of Physicians and Surgeons of BC’s guideline on leaving practice (www.cpsbc.ca/files/pdf/PSG-Leaving-Practice.pdf). 
—Lorne Verhulst, MD
Vice-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This article is the opinion of the Patterns of Practice Committee and has not been peer reviewed by the BCMJ Editorial Board.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.

Lorne Verhulst, MD. Thinking of retiring?. BCMJ, Vol. 59, No. 2, March, 2017, Page(s) 126 - Billing Tips.



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