In the month of March MSP released 5 new updates regarding retroactive payments and billing reminders. The changes affect Critical Care Medicine, Surgeons, Ophthalmology, Pediatrics and Vascular Surgery.
Stay informed by reading each announcement below:
1. Critical Care Medicine: Rate Change for Critical Care
The Critical Care fee codes below have been amended to reflect new rates. Since the new rates are effective as of April 1, 2019 (so almost a year ago) a retroactive payment for any services previously paid at the old rate will appear on your remittance under ‘ adjustment code 80.’
Anything that’s currently in MSP’s system that reflects the old rates will get processed at the new rate under explanatory code BG.
“BG — Amount adjusted to the rate effective for this DOS.”
| Fee Code | Old Rate | New Rate |
|---|---|---|
| 01431 | $114.69 | $117.00 |
| 01441 | $78.75 | $113.00 |
| 01432 | $119.77 | $120.00 |
| 01442 | $101.03 | $110.00 |
| 01443 | $121.22 | $139.00 |
Medical billing in BC is confusing and can often be overwhelming. To help out, check out our complete MSP guide that walks you through each step of medical billing – from the general teleplan process to maximizing your claims and using mobile billing.
2. All Surgeons: Billing Reminder for Timed Surgical Claims
Remember to always add both start and end times when billing time-based surgical procedures with any other surgical procedures (even if start and end times aren’t normally required on the other surgical fees).
Having the start and end times on all items you bill will make sure your claims get paid the first time around. Not adding them sometimes results in your time-based fee codes getting refused.
MSP Examples:
1. If billing for lysis of intra-abdominal adhesions (FI 70650/ 70651) that was consecutive to another surgical item:
Other surgery: 1445 to 1600 hours
70650/70651: 1600 to 1730 hours
2. If billing for Resection of retroperitoneal or intra-abdominal soft tissue tumour measuring 10 cm or greater (FI 71290/ 71291) with another surgical procedure:
Other surgery: 1445 to 1600 hours
71290/71291: 1600 to 1730 hours
3. If billing for lysis of intra-abdominal adhesions (FI 70650/ 70651) that was performed midway through another procedure:
Other surgery: 1445 to 1730 hours
70650/70651: 1515 to 1645 hours
Having both start and stop times clearly indicates how much time was spent during each portion of the procedure, reducing your chances of getting a refusal.
3. Ophthalmology: Billing reminder for fee item 22399
When billing 22399 you have to leave a note in the notes section of the claim confirming the patient’s condition. If you don’t add a note then your claim will come back refused with Explanatory Code “K3.”
“K3 — Processed according to the description of the fee item, or the note relating to the fee item, in the Payment Schedule.”
4. Pediatrics: Retro payments for revised fees
The payment rates for the fee codes below were previously amended. A retroactive payment for claims previously paid at the old rate has now been processed and will appear on your March remittance statement under adjustment code 80.
| Fee Item | Feb 1, 2018 | Apr 1, 2018 | Feb 1, 2019 | Apr 1, 2019 |
|---|---|---|---|---|
| 50515 | $289.81 | — | $291.98 | $307.75 |
| 50516 | $356.71 | — | $359.39 | $378.80 |
| 50517 | $81.40 | $97.82 | $98.55 | — |
| 50518 | $142.52 | — | $143.59 | $151.34 |
| 50519 | $202.71 | — | $204.23 | $215.26 |
5. Vascular Surgery: Description & Note Amended
As of January 1st 2020, the description and notes section for fee item 77402 has been updated.
It used to read ‘Brachiobasilic arteriovenous fistula,vein transpot,’ but has been changed to read as following:
77402 Creation of brachiobasilic arteriovenous fistula with vein transposition. $707.74
The note section has been updated to confirm it’s not payable with the following fee codes:
77260: Bypass graft (autogenous vein) – femoral
77265: Bypass graft (autogenous vein) – popliteal
77270: Bypass graft/anterior/posterior tibial or peroneal
77275: Vein graft – in situ
77280: Non-ipsilateral long saphenous graft – autogenous
77285: Short saphenous graft
77290: Superficial femoral vein graft(extra)
77295: Arm vein graft
77330: Repair of injury of major vessel in extremity – su
77395: Creation of internal arterio-venous fistu
77400: Synthetic av graft for hemodialysis
Broadcast messages are important but often overlooked, make sure you always stay up-to-date so you’re aware of any MSP fee code changes, increases or decreases.
If you have questions about any of the November updates, please reach out to our billing team and we’ll be able to help.
This article offers general information only and is not intended as legal, financial or other professional advice. A professional advisor should be consulted regarding your specific situation. While information presented is believed to be factual and current, its accuracy is not guaranteed and it should not be regarded as a complete analysis of the subjects discussed. All expressions of opinion reflect the judgment of the author(s) as of the date of publication and are subject to change. No endorsement of any third parties or their advice, opinions, information, products or services is expressly given or implied by RBC Ventures Inc. or its affiliates.
