From time to time you will see requests for medical inspectors or audit hearing panel members, and you may wonder why anyone would want to be a medical inspector and audit their peers.

The Medical Services Commission (MSC) is responsible for administering the Medical Services Plan (MSP), which includes remunerating physicians. As part of administering MSP, audits are conducted to ensure physicians have appropriate billing patterns.

As a medical inspector, you will participate in one or more audits by reviewing medical records to assess whether a physician’s MSP billings comply with billing rules. In this interesting and rewarding role, you will be making decisions about appropriate billing practices in accordance with the MSC payment schedule, and you will also help provide explanations to the physician who is being audited. If appointed as a medical inspector, you will be placed on a call list and asked to participate in audits related to your specialty and/or scope of practice. If you are called, the audit will be scheduled based on your availability, and you will have the option to decline to participate if you are unavailable at that time.

When the Audit and Inspection Committee (AIC) requests an on-site audit of a medical practice, an attempt is made to match the medical inspector with the type of practice being audited. Having a peer physician conduct the review is preferred by both the AIC and the physician undergoing the audit and inspection.

The AIC is accepting applications for medical inspectors from any section, but it is currently looking to fill medical inspector roles for the following specialties:

• General practice
• Pediatrics
• Infectious diseases
• Neurosurgery
• Endocrinology
• Neurology
• Psychiatry
• Otolaryngology
• Anesthesiology
• Sleep medicine
• Internal medicine and other medical subspecialties
• General surgery and other surgical sub­specialties

Inspectors are appointed by the AIC under the Medicare Protection Act. Inspectors are responsible for reviewing medical records in order to assess compliance with the MSC Payment Schedule, the Act, and the Regulations.

Conditions of appointment

Candidates must:

• Have a minimum 5 years’ experience in the applicable specialty.
• Be an active registrant with the College of Physicians and Surgeons of BC.
• Have billing practices that fall within the accepted standards of the profession or generally designated by the Patterns of Practice Committee.
• Have the ability to exercise sound judgment.
• Have an understanding and knowledge of the MSC payment schedule.
• Not be subject to circumstances that could give rise to a conflict of interest.

Inspectors are required to:

• Sign a 3-year contract, with possible extension, to be placed on a call list with the Ministry of Health. Once under contract, medical inspectors will be contacted to conduct audits on an as-needed basis. If a medical inspector is contacted, the audit will be scheduled based on the medical inspector’s availability.
• Attend an orientation and training session.
• Attend on-site audits, which may include travel and stay at accommodations outside the medical inspector’s city (length varies from 3 to 5 days).
• Work as part of a team with members of the Billing Integrity Program while on site.
• Inspect medical records, make determinations about compliance with the payment schedule, and flag any quality-of-care concerns.
• Have an exit interview with the auditee to clear up any unanswered questions or obtain explanations of billing issues.
• Review and sign the final audit report.
• Act as a witness before a panel established under the Act, if necessary.
• Maintain confidentiality and independence at all times as required by Section 49 of the Act.

Compensation

Medical inspectors are paid an hourly rate derived from the hourly equivalent of Doctors of BC’s sessional rate for GPs or specialists. Inspectors also receive compensation for eligible travel expenses.

If you are interested in becoming a medical inspector, please contact Tara Hamilton, project coordinator, audit and billing, at 604 638-6058 or thamilton@doctorsofbc.ca.
—Nick Szpakowicz, 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.