Doctors: Learn about potential issues with billings early by checking out your latest mini profile

Your mini profile, a statistical analysis of your billings for the previous calendar year, is now available. Mini profiles are generated for physicians who receive Fee for Service (FFS) payments from the Medical Services Plan (MSP), including any settlements or retroactive payments issued as of March 31, 2020. 

Doctors of BC makes mini profiles available so physicians billing MSP can see if their billings are within the normal statistical boundaries of their peer group. The information is taken from the Physician Annual Profile database used by the Ministry of Health to track billings and to refer to during audits.

The mini profiles provide valuable information that allows you to address any potential issues quickly and early. Understanding the flags on your profile, that could put you at a higher risk of an audit, can help you determine whether you need to make changes to your billings and can alert you to a potential issue with your flagged measures that could be avoided.

Mini profiles include all claims paid by MSP, on behalf of ICBC and WSBC, which identified you as the physician who provided the service, or as the referring practitioner, in addition to GPSC and SSC fee codes.

Please click on the link to access your mini profile. 

Why should you look at it?

• Reviewing your profile allows you see if your billing patterns are within the statistical norm for your peer group. This enables you to identify potential billing issues;
• It can also alert you to fees or services that are flagged – flagging occurs when you are outside the norm with respect to some aspect of service provision or billing. This could potentially put you at a higher risk of audit;
• Understanding the flags on your profile can assist you in determining whether you need to make proactive changes to your billings.

Type of Practice Determination (TOP)

• The Type of Practice is your province wide-comparison peer group into which you have been ​placed for that calendar year;
• Your TOP is determined by the type of services that you were paid for during that calendar year. In other words, TOP correlates with “functional specialty” as opposed to “specialty of record”;
• By classifying each of the MSP Fee-For-Service items that a practitioner has billed, the type of practice can be determined by identifying the most commonly billed specialty; 
• Example: If the majority of earnings of a practitioner are derived from fees for Orthopedic procedures, the practitioner is deemed to be in the Orthopedic TOP regardless of the specialty on record.

Additional Resources

• Doctors of BC provides members with additional resources such as webinars on billing tips, common billing errors, and information on the audit process. These resources can be found under Billing and Audits under Managing My Practice. 

Do you have questions or need help understanding your profile? Contact us:
Doctor of BC Staff Support 
Juanita Grant, Manager, Audit and Billing, Economics, Advocacy and Negotiations
Email: View Email Addressjgrant@doctorofbc.ca