The Medical Services Commission (MSC), not the Patterns of Practice Committee, has regulatory authority over the MSC Payment Schedule.
The Medical Services Commission (MSC), not the Patterns of Practice Committee, has regulatory authority over the MSC Payment Schedule. If changes to the Payment Schedule are sought (e.g., a new form fee), they must go through the Negotiations Committee. The Medicare Protection Act, Section 17, Subsection 1(b) states: “A person must not charge a beneficiary for materials, consultations, procedures, use of an office, clinic or other place or for any other matters that relate to the rendering of a benefit.” The MSC rationale is twofold: one, the drug prescription is medically necessary; two, completing the Special Authority form is a matter related to the rendering of the benefit.
Also, section C. 5 of the General Preamble to the MSC Payment Schedule states: If it is not medically necessary for a patient to be personally reassessed prior to prescription renewal, specialty referral, release of laboratory results, etc., claims for these services must not be made to MSP regardless of whether or not a medical practitioner chooses to see his/her patients personally or speak with them via the telephone.
So, your discretion is advised. Call the patient in if it is medically necessary. The request by the insurer doesn’t really change things. If the drug you prescribe is medically required and would normally be available to the patient under the Pharmacare program, you must follow the above constraints. The insurer is making sure that Pharmacare is the insurer of first resort.
—Lorne Verhulst, MD
Chair, Patterns of Practice Committee
Above is the information needed to cite this article in your paper or presentation. The International Committee
of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally
accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
About the ICMJE and citation styles
The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.
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For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org