Most common billing error seen on audits

Some of the biggest administrative challenges physicians face involve billing and audits. Submitting to MSP can be complex. If billing is not done correctly it can lead to an audit of a physician’s practice, which can be both stressful and time-consuming.

What’s the most common billing error? Recent audits have shown it to be in prolonged counseling fee codes.

Could you be billing these incorrectly?

What is counseling? In the Preamble (D.3.3) of these fee codes in the Doctors of BC Guide to Fees it is defined as “the discussion with the patient, caregiver, spouse or relative about a medical condition which is recognized as difficult by the medical profession or over which the patient is having significant emotional distress, including the management of malignant disease.”

Audits reveal that physicians commonly bill the prolonged counseling fee codes incorrectly for the following services. These services do not qualify under the codes:

• Explanation of test results, multiple problems that took 20 minutes or more.
• Initial or introductory visits to the practice by new patients.
• Travel advice, lifestyle advice.
• Visits for mental health problems that are stable.
• Renewal of prescriptions or a follow-up visit.

General practitioners or specialists should not bill the prolonged counseling fee codes for advice that is a normal component of any visit or as a substitute for the usual patient examination fee. Medical inspectors look for proper documentation in the patient’s record to support the criteria to bill prolonged counseling fee codes—a short summary, advice given, and start and end times (at least 20 minutes). Having little or no documentation in your clinical records to support your claim is interpreted as “you didn’t do the work.”

And remember, the Doctors of BC Fee guide and is available online 24/7 for physicians as a reference tool.  Pay close attention to preambles for interpretations of all fees. Login to your member account for access. For further Billing & Audit resources, click here. 

For questions on the General Fee Guide, please contact Lea Harth at 604 638 2827 or View Email Addresslharth@doctorsofbc.ca.

If you have questions about the auditing process, contact Juanita Grant at 604 638 2829 or View Email Addressjgrant@doctorsofbc.ca

A version of this article originally appeared in the December issue of the BCMJ and is written by Keith J. White, Chair of the Patterns of Practice Committee.