Week 1
EMR VENDORS - answerOscar, Telus Health Wolf, Accuro, Med Access, Profile by Intrahealth
The Medical Services Plan (MSP) - answerinsures medically- required services provided by physicians and supplementary health care
practitioners, laboratory services and diagnostic procedures
THE GENERAL PREAMBLE - answer-Also known as the "Schedule" assist medical practitioners inappropriate billing for insured services.
-It is a list of fees approved by the Medical Services Commission and payable to physicians for insured medical services provided to beneficiaries enrolled with the Medical Services Plan
-Provides the billing rules under which fees are to be claimed; a roadmap designed to clarify the use of the Schedule
DOCTORS OF BC - answerDoctors of BC is responsible for negotiating many
agreements with the Ministry of Health and different
agencies throughout the province, including the Physician Master Agreement, WorkSafeBC Agreements, MOCAP contracts, and local level service, salary, and sessional contracts for individual and groups of physicians.
-Who negotiates the service fees on behalf of the physicians? The Physicians Master Agreement negotiates the service fees on behalf of physicians.
CPSBC - answer-College of Physicians and Surgeons of British Columbia -Regulates the practice of medicine under the authority of provincial law
-All physicians who practise medicine must be registered with the College
-Their role is to ensure physicians meet expected standards of practice and conduct.
MSC - answer-Medical Services Commission
-Manages Medical Services Plan on behalf of the government of British Columbia. -A statutory body that has authority to set the fees that are payable for insured medical service
Antenatal Visit - answer-Pregnancy - related visits from the time of confirmation of pregnancy to delivery.
-Also known as "prenatal"
Palliative Care - answer-Care provided to a terminally ill patient during the final
6 months of life.
-Where a decision has been made that there will be no
aggressive treatment of the underlying disease
-Care is directed to maintaining the comfort of patient
until death occurs.
Transferral - answerThe transfer of responsibility from one medical
practitioner to another for the care of patient
temporarily or permanent.
Specialist - answerA medical practitioner who is a Certified 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.
-LO
Third Party - answerA person or organization other than the patient,
his/her agent, or MSP that is requesting and/or
assuming financial responsibility for a medical or
medically-related service.
-Manulife
-Sun Life
-Blue Cross
Uninsured Services - answerA service that is not a benefit as defined by the MSC
ex. -Dental Care
-Prescription Drugs
-cosmetic surgery
-physiotherapy
-massage therapy
-eye exams
Healthcare practitioners - answer1.Chiropractor
2.Dentist 3.Optometrist
4.Podiatrist
5.Acupuncturist
6.Massage Therapist
7.Midwife
8.Nurse Practitioner
9.Physical therapist
10.Naturopathic physician
general practitioner - answerA medical practitioner who is registered with the
College of Physicians and Surgeons of British
Columbia as a General Practitioner
Administrative Items - answer1.Fees Payable by the Medical Services Plan
2.Inclusive Services and Fees
3.MSP Billing Number
4.Assignment of Payment
5.Adequate Medical Records of a Benefit under MSP
6.Reciprocal Claims
7.Services to Family and Household Members
8.Salaried and Sessional Arrangements
Fees Payable by the Medical Services Plan - answer-The fees listed are the amounts payable by the
Medical Services Plan of BC for listed benefits.
-Benefits under the Medicare Protection Act are
limited to services which are medically required for
diagnosis and/or treatment of a patient.
-Services requested or required by "third party" for
other than medical requirements are not insured
under MSP.
Inclusive Services and Fees - answer-If it is not medically necessary for a patient to be personally reassessed prior to prescription renewal, specialty referral, release of lab results, ets., claims for these 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.
-Some services listed have fees which are specifically
intended to cover multiple services over extended time
period. E.g. Surgical procedures and obstetrical listings
MSP Billing Number - answer-Consists of two numbers -a practitioner number and a
payment number. -Practitioner number: Identifies the practitioner performing and taking responsibility for the service.
-Payment number: Identifies the person or party to whom payment will be directed by MSP.
Assignment of Payment - answer-Legal agreement by which an attending practitioner
designates payment for his/her services to another party. -Example: A practitioner finds a locum (covering physician) to look after patients when he/she is away on medical leave or vacation.
-To authorise MSP to make payment to the designated party, the attending practitioner must complete and file
"Assignment of Payment" form.
-MSP claims will not be accepted until the
Assignment of Payment has been finished and processed.
Adequate Medical Records of a Benefit under MSP - answer- A medical record is not considered adequate unless
it contains all information which may be designated
or implied in the MSC Payment Schedule for the
service.
-Date and location of the service.
-Identification of the patient and the attending
medical practitioner.
-Presenting complaint(s) and presenting symptoms
and signs, including their history
-All pertinent previous history including pertinent
family history.
-The relevant results, both negative and positive, of
a systematic enquire pertinent to patient's
problem(s).
-Identification of the extent of the physical
examination including pertinent positive and
negative findings.
-Results of any investigations carried out during the
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