Client Info


There are many things a client can do to speed up the entry of their claims and reduce their fees. It will help to understand our workflow and processes which are listed below.

Fee coding

We encourage all clients to provide accurate fee codes. If we code, then we will undoubtedly be more conservative and often don’t have enough information from your notes (if any) to make a determination, especially when it comes to procedures. Stopping to read your notes slows us down considerably in the entry process and further delay will be incurred if we have to refer back to you for clarification. Additionally, both MSP and College discourage this practice. We are happy to advise from time to time when you provide a service and cannot find the appropriate code. Your detailed note for us will be helpful or email ahead so we can discuss.

Number of Units

We encourage you to note the number of units you are billing when multiples are involved. This is a safety net as we verify that against your times. If there is a discrepancy, then we will refer back to determine if the number of units is wrong, the times supporting those units are wrong, or if a note record is missing, e.g. CCFPP as in the case of continuing care.

CCFPP

CCFPP is not a fee code, it is a note record that is used when billing ONLY continuing care. It is important to note when the CCFPP notation applies. Continuing care is billed in half-hour blocks to only the last person seen in the payable block, not necessarily using the times the patient was seen or for every patient. The CCFPP notation applies ONLY when you have been with other patients for the full half-hour before the block of time you are billing. Additionally, the first half hour of consecutive continuing care is refractory, and, while not payable, that half hour must be included in the times submitted with your claims.

Dx/ICD9 Coding

MSP does not accept ICD10 codes, codes prefixed with a letter other than V, or suffixed with a letter other than A or B. The only codes accepted are the ones on the MSP Website (see links). Not providing Dx codes will significantly slow down the entry process and limit the number of team members who can enter the claims, as not all are trained to do Dx coding.

Many physicians have asked why accurate Dx coding matters. This is why:

  • Any procedure billed with a GP visit using the same, generic, or a related Dx, or a specialist visit (exception specialists consults) doing the same, will result in only one of the two claims being paid.

  • MSP billable forms for ICBC or MHR using the same, generic or a related Dx code will result in only the form being paid.

  • Generic Dx codes like 780/1 – 789 and codes with descriptions like “multiple” or “other and unspecified”, are considered generic. Use of these can prevent you from being paid for a consult for a full 6 months after your DOS. It also affects your entitlement to full payment when billing visits with procedures.

Times

Start and end times are required for many codes. Additionally, start and end times are often needed even for codes not generally requiring them. E.g. an 1811 being billed with an 1870 or an office visit and a hospital visit billed both on the same day. In some cases, even procedures need times e.g. when billed with an 1870. Call-ins 1200/1/2 and 112 as well as on-site calls 105/113/123 require the time called as the start time, NOT the time arrived. 1205/6/7 requires the time you arrived as the start time. The end time for 1205/6/7, 112, 105/123/113 is the time you left the patient. The time may be adjusted for 1205/6/7 to accommodate the requirement of billing in half-hour blocks, even when there are multiple patients seen in any given block. Please note for deliveries, the following times are required:

  • Time called.

  • Time arrived.

  • Time oxy started and ended, if applicable and you were on-site monitoring.

  • Time the second stage started.

  • Time the baby was delivered.

  • Time the placenta was delivered.

  • Time OR started if applicable.

  • Time OR ended if applicable.

ER Sheets

Your sheets will be entered faster if:

  • They are fee-coded.

  • They are Dx-coded.

  • They are clipped (NOT stapled) in date of service order, not by shift. This is important when working over midnight where there is one shift but two different dates of service.

  • WCBs and private claims are separated as they go to different team members.

  • You provide the time first seen — this is what determines the code. Sheets where the time and code do not match will be referred back to clarify if the code or the times are wrong.

Referring Practitioners

Almost all specialist codes and some GP codes (all GP consults and some GPSC fees) require us to enter the MSP practitioner number of the referring physician (not the name). Telling us the patient was sent by Dr. White in Vernon is not clear enough as our database has no idea where the 12+ registered Dr. Whites work or what their specialties are and we still need the practitioner number to enter the claim(s). If you do not provide this information, the claim will either be referred back to you, causing delays in processing or if you provided the first and last name of the doctor, then we research this through either the College or MSP. We are only successful however if the name you provided is the name they are registered under (not a nickname) and it is spelled correctly. Since MSP has based audits on the matching up of the 3333 no-charge referral (or lack thereof), we will not assume that the Family GP or the last referring physician used is the correct one, as this could be to your detriment if that doctor did not submit the 3333 claim on your behalf. On that same note, ER physicians have triggered the audits of specialists by not noting that they referred a patient out, and to whom. It is important that we bill these 3333 claims for patients you refer as well. At the very least, failure to do so will result in the specialist being paid for a GP visit vs. their consult, and at the very worst, you could trigger and get dragged into the audit of a specialist. 

ER Reassessments

For Level billers, reassessments are now being billed under the 1882 fee item. To bill this fee, you must provide MSP (and your biller) with the following information:

  • The start time of your initial assessment

  • The start time of your reassessment

  • A note record indicating the medical necessity of the reassessment. This only needs to be a sentence or two and should indicate why the patient required a reassessment beyond just being assessed for discharge.

Just because MSP paid your claim does not validate it in any way and it is subject to future debit or being disallowed under audit. 

Lacerations

Please note that laceration codes are to be chosen based on surface length. You cannot add up individual lacerations or multiple layers. Each laceration is to be billed separately under the appropriate code for that repair. Complex laceration repairs are only applicable for areas as stated in the Fee Guide and require specific wording. Any deviation from that wording will result in refusal or adjustment to a lower paying fee. A template has been provided on this site.

Emergency Care Codes

Please note that 81/82 codes are no longer billable by physicians billing 1800-level codes. Please use the new 1870 fee (1871 if you qualify under the trauma rules). ER GP code billers are to continue to bill under the 81/82 codes and we encourage the use of our template to avoid refusals. A single word wrong will result in refusal or adjustment to a lower paying fee item. 

Data Center/Payee Changes

Please remember that once connected to our data center, the signing of a Teleplan Application with any other data center will effectively and immediately sever the connection to Medcom. If you plan to change data centers, an appropriate timeline must be agreed upon ahead of time, as recommended by MSP, to ensure that the transition goes smoothly for everyone.

New Payee Number

If you are incorporating or applying for a new payee number, please remember that this is a two-step process from a billing perspective. It requires not only a new payee number but a connection to an authorized data center. That means while handling the legal portion of incorporation is one part, you still cannot bill as a corporation until other pieces of the puzzle are completed. Please contact us before the completion of the registration of the corporation to ensure that there are no delays in getting your new payee number set up and connected to our data center to facilitate billing.

Valley Medcom Invoices

We invoice monthly for all claims billed from the first cut-off of one month to the first cut-off of the next. Your counts are based on what was submitted between these dates, not on DOS. E.g. An invoice for September services could include claims with DOS from August and even from October, depending on when they were submitted to us, entered, and sent to MSP.

Payment

Payment can be made via old-fashioned check, or e-transfer to Cindy, or you can arrange for auto-debit by contacting Cindy for the required authorization.

Billed vs. Paid

Payment Summaries show the check amount which is the definitive amount deposited to your account for the periods stated on the reports. Please note that the Billed amount on the Summary reports is a billed amount that MSP calculates based on what they processed, not necessarily what was submitted for that period as they hold claims and they pay out previously held claims for any given remittance.

Submission Reports

Submission Reports show a billed amount which is calculated by our software based on submission dates (or the service date depending on filter settings) and will tell you what was sent to MSP for the date range noted. This billed amount is inflated due to resubmissions and adjustments. We bill everything at 100% so we can monitor ALL adjustments made by MSP and ensure that the result is correct but that inflates the billed amount. Also each time we do a rebill, the billed amount is inflated — for example, if a claim for $100.00 is refused and rebilled, the submitted amount will be $200.00 for that claim but only $100.00 of it will ever be realized, and maybe even less if it was a visit with a procedure and adjusted to 50% or even zero if refused outright again. The more billing and rebilling we do and the further apart the report dates are, the further away the Billed vs. Paid figure gets. 

Claims held by MSP

MSP holds claims for every RMT. These will eventually appear on a future report as Paid, Adjusted, or Refused and are managed appropriately at that time. MSP is under no mandate to process claims in any particular order or time frame. Claims held over 90 days and then paid will have an interest adjustment applied. Generally, the more often you submit claims, the fewer held claims you will have.

RMT Reports

Full detailed RMT reports are available and will show the disposition of each claim that was processed by MSP for that RMT period but these amounts won’t match because there may be adjustments, WCB lifts, retro payments, interest paid, etc. that affect the final paid/deposited amount.

Different sets of reports cannot necessarily be compared against one another and while they may use the same terminology e.g. “billed” and “paid”, they each have their own value based on the information provided, how the figures are pulled from the system, and what they represent. It’s important that you understand what that data is reflecting. Billed and Paid will NEVER match and the difference between the two is NOT necessarily (and unlikely to be) what the doctor is owed. That figure can be obtained from an outstanding receivables report.

Any questions about the information above can be directed to Cindy. The best way to reach her is via email at cindy@valleyvistabilling.ca.