MSP supplementary benefits include

• physiotherapy
• chiropractic
• naturopathy
• massage therapy
• acupuncture and
• non-surgical podiatry.

Acupuncturists, chiropractors, massage therapists, naturopathic doctors, physical therapists, and non-surgical podiatrists are often referred to as supplementary benefits practitioners.

Supplementary benefit practitioners are allowed to

• bill MSP for services only to the patients who are eligible for MSP supplementary benefits coverage and
• charge their patients more than covered by MSP (opt out of MSP Fee Schedule). The difference is paid by patients out-of-pocket.

MSP does not provide coverage for the following:



• chiropractic,
• physiotherapy,
• naturopathy,
• massage therapy,
• acupuncture, and
• non-surgical podiatry services for persons not receiving MSP premium assistance.



Healthcare practitioners should not bill MSP for those services. They should bill their patients directly.

Allied health professionals can use Claim Manager to

• bill MSP for the insured benefits,
• bill patients and/or group benefits plans for the fee difference if opt-out,
• bill patients and/or group benefits plans for services  excluded from  MSP coverage.

Keeping all your billing in one electronic system makes your billing and income reporting quick and easy.

The MSP fees for allied health professionals are established through consultation between the Medical Services Commission and the respective professional association. Billing MSP for services that are not on the MSP Fee Schedule or billing MSP for higher amounts is not permitted.

• 00138 – Chiropractic Service: $23.00
• 00142 – Acupuncture Service: $23.00
• 09938 – Physiotherapy Service: $23.00
• 09948 – Massage Therapy Service: $23.00
• 00145 –  Naturopathy Service: $23.00
• P00189 – Podiatry Visit: $23.00

Under the Medical Protection Act, eligible residents of B.C. must enroll themselves and their dependents with Medical Services Plan (MSP). If your patients have questions about MSP enrollment eligibility, please refer them to the MSP eligibility and enrollment web page.

All MSP beneficiaries fall under two categories:



• MSP Regular Premiums patients and
• MSP Premium Assistance patients (regular and temporary).



The division is defined by the amount of MSP premiums paid by the patients. The second group pays discounted premiums that can be as low as $0.00.



Only MSP premium assistance patients are eligible for MSP benefits for allied health services, such as acupuncture, massage therapy, physiotherapy, non-surgical podiatry, naturopathic and chiropractic services.



If your patients have questions about eligibility for MSP premium assistance, refer them to the MSP premiums web page and to the MSP premium assistance eligibility calculator.

MSP enrollment is confirmed by issuing an applicant the BC Services Card (former BC CareCard). Being presented with the healthcare card is not enough to verify the patient’s MSP enrollment or MSP Premium Assistance status because the patient may carry a prematurely expired MSP card and because MSP Premium Assistance status is not indicated on the card. To verify the patient’s MSP eligibility on the date of service, practitioners need to make an eligibility inquiry to MSP.

The MSP Premium Assistance status is granted based on the patient’s annual income. However, MSP extended the list of patients eligible for supplementary benefits to include:

• MSP Premium Assistance Recipients;
• Income Assistance recipients;
• Convention refugees;
• Inmates of B.C. Correctional Facilities;
• Individuals enrolled with MSP through the At Home Program;
• Residents of long term care facilities receiving the Guaranteed Income Supplement (GIS);
• Individuals enrolled with MSP as Mental Health Clients; and
• First Nations individuals with valid B.C. Medical Plan coverage through the First Nations Health Authority.

If your patient falls under any of these categories, the MSP eligibility report will show his or her eligibility for subsidy insured services (another name for supplementary benefits).

In a calendar year, MSP premium assistance patients qualify for up to ten combined visits to the supplementary benefit practitioners under the MSP coverage. After ten visits they pay out-of-pocket.

Allied health professionals need to confirm the patient’s MSP premium assistance status and the number of paid MSP benefits before submitting an MSP claim.

Bill MSP if the MSP eligibility report on the date of service shows that

• The patient “Is Eligible for Medical Coverage Under MSP” and
• “Subsidy Insured Service: SERVICES PAID TO DATE” is less than 10.

Note:

• “Services paid to date” shows the number of MSP supplementary visits paid in the current calendar year. The maximum number of paid services is ten.
• Applies only to physiotherapists, chiropractors, naturopaths, registered massage therapists, acupuncturists and non-surgical podiatrists.

There are four ways to check the MSP eligibility of a patient.

1. Request an instant MSP coverage report in Claim Manager.
2. Call the automated Practitioner Information Line:
   • Victoria: (250) 952-3102 or (250) 383-1226
   • Vancouver: (604) 669-6667
   • Toll-free: 1 800 742-6165
3. Use MSP Web Access.
4. Fax a request on a coverage research form if the PHN is unknown:
   • fax: (250) 952-3101.

Notes:

1. The services are listed in order of convenience.
2. The patient’s personal health number (PHN) must be provided for steps 1, 2 and 3.
3. MSP Teleplan registration is required for steps 1 and 3.
4. Practitioner Information Line is an automated service that handles coverage inquiries using an interactive voice response (IVR) system.

Claim Manager conducts an instant MSP eligibility check on any date of service within the last six months in the current calendar year. It shows the complete MSP eligibility report, including the number of paid supplementary benefits.

Check MSP coverage on each visit. MSP premium assistance might expire or appear midyear.

MSP coverage report might show an inaccurate number of paid supplementary benefits because MSP processes claims only twice a month. Any claims held in process by MSP are not reflected in the MSP coverage report.

How to manage

• Submit your claims as soon as possible.
• Ask your patients if they have visited another supplementary benefits practitioners in the last two weeks.
• Do not go over the limit of ten claims yourself.

MSP coverage report shows the number of services that were paid up-to-date, regardless of the service dates. Whether you want to bill for today’s or yesterday’s visits, it  does not change the fact that x number of visits out of ten were already paid. That is why MSP coverage report shows the same number of paid visits on any day of service.

Always check MSP coverage on past days of service to identify patients whose MSP coverage was revoked or established midyear.

Unfortunately, not. MSP eligibility report can be requested on any date of service within the last six months, but only in the current calendar year. The counter of used MSP benefits resets on January 1.

How to manage

• Check eligibility on the date of service and do your billing same day. Do not procrastinate.

MSP services are paid in the order “first come, first served”. Submit your MSP claims as soon as possible to beat the claims by other allied health professionals.

MSP contributes only $23 towards the cost of each eligible visit to an allied health professional; however, the allied health services usually cost more.

MSP Soft and Hard Opt Out practitioners can charge MSP premium assistance patients any amount. MSP Opt In practitioners can only charge the amount on the MSP fee schedule.

Only MSP Hard Opt Out Practitioners can bill $23 to patients directly, but they still have to submit the patient’s claim to MSP so that MSP can reimburse the patients. Soft Opt Out and Opt In practitioners must bill MSP benefits to MSP and the remainders of their fees, if any, to patients.

Supplementary benefits practitioners can choose who is going to be the payee of MSP benefits: the practitioner, the clinic, or the patient. All MSP payments are made to the same payee unless the practitioner requests otherwise. The payee is determined by the practitioner’s setup with MSP.

Hard Opt Out providers have MSP benefits paid directly to the patients. Soft Opt Out and Opt In practitioners have MSP benefits paid to the practitioners or the clinic.

Claim Manager takes the complex and exciting world of supplementary practitioners’ billing and distills it into simple foolproof steps. All restricted operations are trimmed off. All potential payees are listed. All streams of revenues are accounted for. Eligibility is verified and a single transaction is broken into a series of insurance claims with a remaining balance payable by the patient.

According to section 29 of the Medical and Health Care Services Regulation, healthcare practitioners are not allowed to bill MSP for personal services.



29 (1). Personal Services



(1) Services are not benefits if they are provided by a health care practitioner to the following members of the health care practitioner’s family



(2) Services are not benefits if they are provided by a health care practitioner to a member of the same household as the health care practitioner

MSP benefits are only payable if an adequate clinical record has been created and maintained. Section 16 of the Medical and Health Care Services Regulation lists requirements for an “adequate clinical record” – See Appendix A.


Appendix A – Medical and Health Care Services Regulation (Part 4)


Services of Health Care Practitioners

Definition

16. In this Part, “adequate clinical record” means a record of a health care practitioner, prepared in accordance with the applicable payment schedule, that contains sufficient information to allow another practitioner of the same profession, who is unfamiliar with both the beneficiary and the attending practitioner, to determine from that record, together with the beneficiary’s clinical records from previous encounters, information about the service provided to the beneficiary including:

(a) the date, time and location of the service;

(b) the identity of the beneficiary and the attending practitioner;

(c) if the service resulted from a referral, the identity of the referring practitioner and the instructions and requests of the referring practitioner;

(d) the presenting complaints, symptoms and signs, including their history;

(e) the pertinent previous history including family history;

(f) the positive and negative results of a systematic inquiry relevant to the beneficiary’s problems;

(g) the identification of the extent of the physical examination and all relevant findings from that examination;

(h) the results of any investigations carried out during the encounter;

(i) the differential diagnosis, if appropriate;
(j) the provisional diagnosis;

(k) the summation of the beneficiary’s problems and the plan for their management.



For the purposes of Section 16, clinical records must be created and maintained in English.