By: Keith J. White, MD
New Laboratory Services Act: What does it mean for physicians?
Issue: BCMJ,
vol. 58, No. 4, May 2016,
Page 220 Billing Tips
The Laboratory Services Act (LSA) came into effect on 1 October 2015. The LSA replaces 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.
Be sure you are familiar with 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 in order 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 Laboratory Services Act, 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.
—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This article is the opinion of the Patterns of Practice Committee and has not been peer reviewed by the BCMJ Editorial Board.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.