This article originally appeared in the May 2016 issue of the BCMJ. As this subject continues to pose a problem, the Patterns of Practice Committee decided to rerun the article.
The Laboratory Services Act (LSA) came into effect on 1 October 2015. The LSA replaced the Medicare Protection Act (MPA) and the Hospital Insurance Act as the authority for insuring laboratory services. It consolidates responsibilities for the governance, funding, and service delivery oversight of all publicly funded laboratory services in the province.
While the enrolment, auditing, and patterns of practice of referring practitioners remain under the MPA, the LSA reinforces an item of particular significance to physicians in Section 54: Recovery from referring practitioner(s).
You should be aware of the following facts when ordering laboratory services:
- A laboratory service is only a benefit when done at the request of a referring practitioner.
- There must be a corresponding insured benefit under the MPA for the referral to be valid under the LSA.
- A recovery can be made from a referring practitioner if a payment is made in violation of this prohibition.
Also, be aware of which payment method is selected on the lab requisition. MSP is the default payee if an alternative payee (ICBC, WorkSafe BC, patient-pay) is not selected, and some EMRs may default to billing MSP. If an inaccurate payment method is selected it could result in the cost of the test being recovered from you, the referring practitioner.
You are encouraged to read Sections 52–54 of the LSA; this information may have a significant impact on the recovery process for the cost of lab tests that are not evidence-based or are ordered as a benefit for nonbenefit visits.
For more information about the LSA, go to www.gov.bc.ca/laboratoryservices.
In the next issue of the BCMJ we will provide examples of circumstances under which recovery for lab-test costs may be sought.
—Janet Evans, MD, CFPC, FCFP
Chair, Patterns of Practice Committee
This article is the opinion of the Patterns of Practice Committee and has not been peer reviewed by the BCMJ Editorial Board.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 Tara Hamilton, audit and billing advisor, Economics, Advocacy and Negotiations, at 604 638-6058 or firstname.lastname@example.org.
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