Some of the biggest administrative challenges you face as a physician involve billing and audits. Submitting bills to MSP can be complex and if not done correctly can lead to an audit of your practice.
We are here to help lower your risk for an audit and should it happen, to support you through an audit process. In this section, you will find some useful information and links to a number of supports.
The Audit and Inspection Committee is a four-member panel comprised of three physicians (one appointed by Doctors of BC one appointed by the College of Physicians and Surgeons of BC and one appointed by government) together with one member who represents the public. The Medical Services Commission (MSC) has delegated to the AIC its powers and duties under s.36 of the Medicare Protection Act to audit and inspect medical practitioners. On December 1, 2006, s.10 of the Medicare Protection Amendment Act 2003 was brought into force. This section expanded the audit and inspection powers of the MSC to include the power to audit clinics as corporate entities, rather than just physicians.
The AIC has responsibility for two types of audits. Patterns of practice audits are done to ensure that services billed to MSP have been delivered and billed accurately. Extra billing audits focus on whether beneficiaries are being charged for services in contravention of the Medicare Protection Act. The AIC decides whether onsite audits are appropriate, and it outlines the nature and extent of the audits. It also reviews the audit results and makes recommendations to the Chair of the Medical Services Commission for further appropriate action.
The Billing Integrity Program provides audit services to the Medical Services Plan and the Medical Services Commission (MSC). The MSC is authorized to monitor the billing and payment of claims in order to manage medical and health care expenditures on behalf of MSP beneficiaries. BIP monitors and investigates billing patterns and practices of medical and health care practitioners to detect and deter inappropriate and incorrect billing of MSP claims. In cooperation with the professions, BIP develops and applies monitoring, case finding and audit criteria, and assists the MSC in the recovery of any funds billed in appropriately. It carries out the audit and inspection function on behalf of the AIC.
The Patterns of Practice Committee is a committee of Doctors of BC that acts in an advisory capacity to the MSC. The POPC prepares and distributes an annual statistical personal profile summary (mini-profile) to fee-for-service physicians, provides educational information to physicians on the audit process and their patterns of practice, listens to physicians who wish to raise their concerns about the audit process, is informed of, and provides feedback on, the audit practices employed by the BIP and jointly, with the College of Physicians and Surgeons of BC, nominates medical inspectors and audit hearing panel members.
The Reference Committee acts, upon requests from physicians, in an advisory capacity to the MSC, on the adjudication of billing and payment disputes between physicians and the MSP. The confidential membership on the Reference Committee is limited to representatives of the BCMA. The Committee meets every 6 months depending on the number of cases on the agenda.
For more information on how new cases are reviewed by the Reference Committee, please click here.
|Doctors of BC||Phone|
|Dr Sam Bugis - Executive Director, Physician and External Affairsfirstname.lastname@example.org|
|Ms Juanita Grant - Manager, Audit and Billing, Physician and External Affairsemail@example.com|
|Ms Tara Hamilton - Project Coordinator, Audit and Billing, Physician & External Affairsfirstname.lastname@example.org|
|Ms Suzie Fox - Administrative Assistant, Physician & External Affairemail@example.com|
|Other Useful Contacts||Phone|
|Billing Integrity Program (BIP)||firstname.lastname@example.org|
|College of Physicians and Surgeons of British Columbia (CPSBC)||604.733.7758 Toll free: 1.800.461.3008||www.cpsbc.ca|
|Harper Grey Lawyersemail@example.com|
|HIBC||Monday to Friday, 8:00 am to 4:30 pm PST (except statutory holidays) Metro Vancouver: 604.683.7151 Toll-free: 1.800.663.7100||www.health.gov.bc.ca/insurance|
|The Canadian Medical Protective Association||Monday to Friday, 8:30 a.m. to 4:30 p.m. EST Toll-free: 1.800.267.6522||www.cmpa-acpm.ca|
|Physician Health Program (PHP)||Help is available 24/7 at