Billing, rebilling

The devil is often in the details. In the case of the new fee agreement with the government that is certainly true.

I want to bring to your attention the consequences of the implementation of the new fee schedules for GPs. There will be five age differential fees for patients. If a wrong age-related fee code is submitted for a given age, the fee will be rejected, as is presently the case. There are inevitably going to be large volumes of refusals, which mean delayed payment and increased work in rebilling.

At this time the specification has not been released to vendors. I have brought the matter to the attention of the Section of General Practice. The extremely restrictive rejection of claims policy should be replaced by a much more permissive payment policy. If I make a 0100 claim for an office visit for a patient that is another claim category, then that claim at the very least should be paid at the 0100 level. It would even be nice for MSP to amend the fee to the correct age-related level. After all if the MSP computers have enough information to reject the claim based on age-related criteria, they have enough information to pay the claim in the first place and at the right level.

Another thing—if I submit a bill before the 90-day deadline, then that claim should never be rejected as stale-dated after 90 days. After all, I put the bill in before the deadline. It would require very little change to never reject a bill as over the 90-day limit if it was initially submitted before that date. I need not remind anyone of the considerable effort required now to have the claim reinstated.

—Peter V. Richards, MB
North Vancouver

Peter V. Richards, MB. Billing, rebilling. BCMJ, Vol. 45, No. 2, March, 2003, Page(s) 73 - Letters.



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