Bill 92 extra billing provisions Information for Practitioners

Transcription

1 Bill 92 extra billing prvisins Infrmatin fr Practitiners Q1. What is extra billing? Extra billing invlves charging a MSP beneficiary r their representative fr a benefit cvered by MSP, r fr any matter related t rendering f a benefit, unless therwise permitted under the Medicare Prtectin Act r by the Medical Services Cmmissin. Benefits cvered by MSP are charged directly t MSP. Extra billing als includes charging fr pririty access t waitlisted benefits. Under Sectin 18 f the Medicare Prtectin Act, a practitiner wh is nt enrlled in MSP is nt permitted t charge fr prvisin f a benefit any mre than the rate payable by MSP if they were enrlled, s lng as the service is prvided in a hspital, a cntinuing care facility, publicly funded cmmunity care facilities r assisted living residences, r a health authrity. Q2. What is changing n Octber 1, 2018? Gvernment is amending the Medicare Prtectin Act t bring additinal sectins int frce. These changes include: Making it an ffence t extra bill, and creating significant financial penalties (s. 46(5.1)(5.2)) 1 ; Creating cnsequences fr practitiners, r thers, such as privately-wned medical clinics, wh have extra-billed beneficiaries. There will be new ffence prvisins, including fines f up t $20,000 fr repeat ffences f extra billing. The Medical Services Cmmissin will nw have cause t cancel the enrlment f practitiner frm MSP under certain circumstances (s.15) Clarifying that selling pririty access t medically-necessary care is extra billing (s. 17(1.1)); The amendments prvide new prtectins fr beneficiaries and establish that they are nt liable t pay fr extra billing charges. Under the new prvisins, the Medical Services Cmmissin can refund the beneficiary directin and then recver the charge frm the persn wh impsed it (s. 17(1.2), 18(4), 18.1(3), 19(4), 20, 21); These changes are applicable t bth private and public facilities. Changes t the Medicare Prtectin Act will be in frce as f Octber 1, s. is shrt frm fr sectin; referring t a specific sectin f the Legislatin. 1 P a g e

2 Q3. Wh is affected? These changes affect medically necessary insured benefits prvided by medical practitiners (physicians). Medical practitiners shuld ensure they are aware f the scpe f these changes t ensure they cntinue billing apprpriately as per the Medicare Prtectin Act. These amendments expand the limitatins n direct billing t beneficiaries by nn-enrlled medical practitiners. Q4. Why is this happening nw? These amendments were riginally passed by the Legislative Assembly in 2003, but were nt brught in t frce at that time. Bringing these sectins f the Medicare Prtectin Act int frce and intrducing penalties fr nn-cmpliance will ensure that eligible BC residents (beneficiaries) receive quality public health care based n need, nt n ability t pay. These changes uphld the fundamental principles f the Medicare Prtectin Act as well as the Canada Health Act. With this implementatin f Bill 92, the Prvince is psitined t recver $15.9 millin in fines incurred under the Canada Health Act fr extra billing by private clinics. Q5. Where can I find the legislatin being referenced? Bill 92 (i.e. the amendment t the Medicare Prtectin Act) can be fund n the BC Laws website at: The current versin f the Medicare Prtectin Act (which des nt include the Bill 92 amendments) can be fund at: An fficial updated versin f the Medicare Prtectin Act will be available after Octber 1, Q6. Des Bill 92 apply t labratry services? In 2015, the Labratry Services Act (LSA) was enacted and replaced the Medicare Prtectin Act and the Hspital Insurance Act as the authrity fr insuring labratry services in the prvince. As a cnsequence, changes t the Medicare Prtectin Act resulting frm Bill 92 d nt apply t services gverned by the LSA. Q7. What is happening n April 1, 2019? Sectin 18.1 f the Medicare Prtectin Act related t limitatins n extra billing in diagnstic facilities will cme in t frce n April 1, The six-mnth extensin fr the sectin f Bill 92 applicable t diagnstic services takes int cnsideratin the gvernment s cmmitment t increase publicly funded MRI exams thrugh new capacity, while making sure that public investments are used t decrease wait lists. 2 P a g e

3 Q8. Will gvernment be pursuing retractive payments frm private clinics that have been extra billing in the past? N, these changes will apply t benefits delivered frm Octber 1, 2018 nwards. Q9. What des this mean fr enrlled medical practitiners n Octber 1, 2018? In general, practitiners are billing apprpriately as utlined in the Medicare Prtectin Act; therefre, these amendments shuld have minimal impact n day-t-day wrk. The list f insured benefits is nt changing as a result f these amendments. The amendments clarify that n persn can be charged fr prvisin f benefits t MSP beneficiaries, r fr any matter relating t rendering benefits, unless therwise permitted under the Medicare Prtectin Act r by the Medical Services Cmmissin. Such charges are cnsidered extra billing. The new prvisins als address arrangements where a clinic (rather than an individual practitiner) charges a persn in relatin t prvisin f benefits t an MSP beneficiary. Under the new prvisins, this will als be cnsidered extra billing and may be grunds fr deenrllment f the practitiner invlved in prviding the benefit. These amendments d nt prhibit practitiners frm levying legitimate charges fr cmpletin f physician s ntes fr emplyers and ther nn-benefits (e.g. elective csmetic prcedures). Q10. Hw des this prcess wrk hw will this be enfrced? The Ministry f Health will investigate allegatins f extra billing brught frward by beneficiaries r ther individuals, n behalf f the Medical Services Cmmissin. In these circumstances, medical practitiners and/r clinics will be ntified if it appears they may have extra-billed a beneficiary and may be asked t prvide dcumentatin t assist in making a final determinatin. Practitiners and/r clinics will have the pprtunity at this juncture t repay the beneficiary prir t being directed t d s by the Medical Services Cmmissin. Additinal infrmatin will be prvided t practitiners and/r clinics when cntacted by the Ministry n behalf f the Medical Services Cmmissin. A beneficiary (r the persn wh pays fr the benefit) will be entitled t a refund if the Cmmissin determines thrugh investigatin that extra billing has ccurred. The payment will be refunded at the amunt indicated fr the benefit in the MSP payment schedule, and may be recvered directly frm the practitiner by the Medical Services Cmmissin if the beneficiary (r the persn wh pays fr the benefit) elects t assign their debt t the Cmmissin. The debt may be recvered by way f adjusting a practitiner s future MSP payments r thrugh ther available cllectins prcesses. There will be new enfrcement prvisins in the Medical Prtectin Act related t extra billing, including fines f up t $10,000 fr a first ffence and up t $20,000 fr a secnd r subsequent ffence. 3 P a g e

4 The Medical Services Cmmissin will have cause t cancel the enrlment f a practitiner wh: (a) cntravenes; (b) attempts t cntravene; r (c) authrizes, assists r allws smene else t cntravene, the extra billing prvisins in the Medicare Prtectin Act. Q11. Wh can I cntact with questins abut billing rules? Fr questins specific t the implementatin f Bill 92, please cntact MSC@gv.bc.ca. If yu have questins regarding practitiner billing, fee items, r the MSC payment schedule generally, please cntact: Health Insurance BC Billing Supprt PO Bx 9480 Stn Prv Gvt Victria, B.C. V8W 9E7 Vancuver: (604) Elsewhere in B.C.: Q12. What des this mean fr nn-enrlled medical practitiners n Octber 1, 2018? If a nn-enrlled medical practitiner renders a service t a MSP beneficiary that wuld be cnsidered a benefit if rendered by an enrlled practitiner, n persn may be charged fr the service, r fr any matter relating t the rendering f the service, an amunt in ttal greater that the amunt that wuld be paid by MSP t an enrlled practitiner fr the rendering f the benefit, prvided the service is rendered in: A hspital as defined in sectin 1 f the Hspital Act, A facility as defined in sectin 1 f the Cntinuing Care Act, A cmmunity care facility r assisted living residence as defined in sectin 1 f the Cmmunity Care and Assisted Living Act that receives funding fr the service thrugh a reginal health bard, the Nisga a Natin r the Prvincial Health Services Authrity (PHSA), r A medical r diagnstic facility if the service was cntracted by a reginal health bard under sectin 4 f the Health Authrities Act r by the PHSA. If the service is prvided in any f the abve lcatins and the amunt charged is greater than the MSP amunt, it is cnsidered extra billing and the persn charged is nt liable t pay the amunt charged. The new prvisins als address arrangements where a clinic (rather than an individual practitiner) charges a persn in relatin t prvisin f benefits t an MSP beneficiary. Under the new prvisins, this will als be cnsidered extra billing and may be grunds fr deenrllment f the practitiner invlved in prviding the benefit. Q13. What des this mean fr health care practitiners (nn-physician)? These changes d nt affect prvisin f nn-physician health care services that are nt insured by either MSP r the Hspital Insurance Act. Health care practitiners prviding these services will be able t cntinue billing as dne prir t the amendments t the Medicare Prtectin Act. 4 P a g e

5 Q14. What des this mean fr private prviders in partnership with health authrities? These amendments d nt preclude health authrities frm partnering with private care givers r private clinics, s lng as these private prviders are in cmpliance with the Medicare Prtectin Act and nt engaging in extra billing. Hwever, fr the delivery f health authrity-cntracted services, private clinics may nly use medical practitiners wh are enrlled and pted-in under MSP. Q15. What des this mean fr insured benefits prvided at private medical r diagnstic facilities? While private facilities can prvide an unlimited number f services t MSP beneficiaries, it is illegal fr them t charge fr r in relatin t services that are insured as benefits thrugh MSP r under the Hspital Insurance Act. The Medical Services Cmmissin may recmmend charges that culd result in fines up t $20,000 fr extra billing r participating in a scheme t extra bill (e.g. where a facility charges fr prvisin f an benefit t a MSP beneficiary). Medical practitiners may als be rdered t repay MSP r be de-enrlled frm the plan. Q16. What des this mean fr nn-insured services prvided at private clinics? These changes d nt prevent beneficiaries frm chsing t pay fr services that are nt medically necessary and therefre nt benefits insured thrugh MSP r under the HIA (e.g. elective csmetic prcedures). 5 P a g e