Extra Billing and Balance Billing

“Extra Billing” means billing an amount over the amount payable for an insured service (a “benefit”) by MSP. Extra billing is not allowed under the Medicare Protection Act except for services rendered by medical practitioners who are not “enrolled” with MSP (i.e., no services are covered by MSP) and then only for those services which are rendered outside of hospitals and community care facilities. 

“Balance billing” denotes the practice of medical practitioners who are opted in under MSP billing MSP for the MSP fee and the patient for the amount of the difference between the payment made by MSP for an insured service and the fee for that service listed in the BCMA Guide to Fees, under the heading “BCMA Fee.” Except as defined by differential billing for non-referred patients above, balance billing is not permitted under the Medicare Protection Act.

Differential Billing for Non-Referred Patients

If a specialist attends a patient without referral from another practitioner authorized by the Medical Services Commission to make such referral, the specialist may submit a claim to MSP for the appropriate general practitioner visit fee and in addition may charge the patient a differential fee. This is not considered “extra billing.” 

The maximum amount the patient may be charged is the difference between the amount payable under the General Practice Payment Schedule for the service rendered, and the amount payable under the Payment Schedule to the specialist had the patient been referred.

Missed Appointments

Claims for missed appointments must not be submitted to MSP. Billing the patient directly for such missed appointments would not be considered extra billing.

Payment for Specialist Consultations/Visits and specialty-restricted items 

To be paid by MSP, ICBC or WorkSafeBC for specialist consultations, visit items and/or other specialty-restricted fee items listed in the specialty sections of the Payment Schedule, one must be a Certificant or a Fellow of the Royal College of Physicians and Surgeons of Canada and/or be so recognized by the College of Physicians and Surgeons of British Columbia in that particular specialty. 

A specialist recognized in more than one specialty by the College of Physicians and Surgeons of British Columbia should bill consultation and referred items under the specialty most appropriate for the condition being diagnosed and/or treated for that referral/treatment period.

Motor Vehicle Accident (MVA) Billing Guidelines 

1. All cases directly relating to an MVA which ICBC Insurance coverage applies should be identified as such by a “yes” code in the Teleplan MVA field. 

2. All such cases should be coded “MVA” regardless of whether seen in an office visit, emergency, lab or x-ray facility. Surgery or procedures performed in regard to these cases should also be identified. 

3. Where possible, please attach an ICBC claim number to each coded MVA in your Teleplan billing. 4. In cases where a visit or procedure was occasioned by more than one condition, the dominant purpose must be related to an MVA to code it as such. 

5. If the patient is from another province, use the normal out-of-province billing process. 

6. In those instances in which the patient has no MSP coverage, the medical practitioner should bill the patient or ICBC directly. Medical practitioners have the choice of either billing the uninsured patient directly at the BCMA recommended rate and having the patient recover the costs from ICBC (see BCMA Guide to Fees), or billing ICBC for the MSP amount. 

7. If the MVA is work-related, WorkSafeBC (WSBC) should be billed under their procedures. 

8. Medical Practitioners are accountable for proper MVA identification and are subject to audit.