Examining collegiality in Saskatchewan - Saskatchewan Medical ...

Physician sings high praise for billing review session
By Doré Collett
In January, Dr. Eben Strydom contacted SMA News Digest with
high praise for a workshop he had just attended about correct
billing of services. He wanted to share specifics with his colleagues
that he found were particularly interesting and useful.
Charlene Koch, a field officer with Saskatchewan Health’s
Medical Services Branch, presented the session in Melfort
that Dr. Strydom attended. “It is always great to hear that
the billing review sessions are beneficial,” explained Ms.
Koch, who was on her way to Maidstone, Lloydminister, and
then North Battleford to conduct similar sessions.
The GP billing review session covers a variety of items, including:
physician responsibilities, the payment schedule,
assessment rules, explanatory codes, a claims processing
overview, frequently used codes, a review of payments, and
common billing scenarios.
Throughout the sessions, which typically run 2.5 hours, she
provides plenty of opportunity for Q&A. Participation by physicians
and billing staff adds to the learning experience. Of her
experience with the sessions so far, Ms. Koch expresses that
“the physicians always say that they take away something new
that they didn’t know previously, or the session reminded them
of something they used to know but have since forgotten.”
The field officer role is a key resource for physician billing information.
In addition to the sessions offered, Ms. Koch meets
with individual physicians and their billing staff to review,
discuss, and explain the physician payment schedule requirements
and billing codes and their appropriate applications.
Meetings are at the request of the physicians and their billing
staff or may be initiated by the field officer. Ms. Koch provides
education to physicians who are Canadian-trained or international
medical graduates, who are new to the province or who
have been practising in the province for some time.
Presentations are also delivered to family medicine residents
who are entering their second year of residency.
Dr. Strydom’s question was resident-related. He found it quite
helpful to know that “a service which is insured by the government
when provided by a physician is also insured when provided
under the supervision of a physician. Payments can be
made to the physician for this supervision as long as the physician
is available to intervene promptly if necessary. Payment
for a supervised service may only be made to the physician
providing the supervision.” For more details about this insured
service, view page In.17 of the Physician Payment Schedule.
With the recent media regarding MS patients seeking treatment
in other countries, Ms. Koch mentioned that a hot topic
during site visits involves an explanation of patient referrals
for out-of-Canada medical coverage. She acknowledged there
are situations which arise wherein the Ministry of Health
grants prior approval for out-of-Canada medical coverage
for Saskatchewan residents in exceptional circumstances. In
order for Saskatchewan residents to receive this out-of-Canada
medical coverage, their referring specialist must request
and receive prior approval from the Ministry of Health prior
to seeking the treatment outside of Canada. The specialist’s
written request must describe the circumstances of the case,
the services requested, and their indication that, to the best
of their knowledge, the medical service is not available anywhere
in Canada. If the application for out-of-Canada coverage
is approved, the Ministry of Health will pay the treatment
costs. “When GPs submit these applications, it slows down the
process,” explains Ms. Koch. “I recommend coordinating with
the appropriate specialist instead of submitting a request that
will not be approved.” Further details about this billing topic
can be found on page In.6 of the Physician Payment Schedule.
To book a meeting or to inquire about the billing review sessions offered
by the Medical Services Branch, please contact Charlene Koch
at (306) 798-2108 or by email at ckoch@health.gov.sk.ca.
For further information and billing details, you can review the Physician
Payment Schedule. A link to the payment schedule is available
on the SMA website, under the Fees and Negotiations tab.
14 Spring 2011 SMA News Digest