General Practice BILLING GUIDE - British Columbia Medical ...

A GP SERVICES COMMITTEE INCENTIVES
8. Where can I find the clinical guidelines?
The guidelines are summarized below. The full diabetes care, heart failure care, and
the treatment of essential hypertension guidelines are found on the Guidelines and
Protocols page of the Medical Services Plan web site, http://www.bcguidelines.ca.
A link is also provided on the BCMA web site, http://www.bcma.org/log-in member
(look under Popular Topics for Members – MSC/BCMA Clinical Guidelines).
9. Can I apply for the payment even if the clinical or laboratory objectives
have not been met?
The payment is provided for the provision of guidelines-based care and is not a
payment simply because the patient has a diagnosis of diabetes, congestive heart
failure, or hypertension. However, you may still claim for the payment if you have
attempted to provide the appropriate level of care but for some reason care objectives
have not been met. If this is the case, however, for audit purposes you must have clear
chart entries that show that you attempted to provide the recommended level of care.
You may also still apply for the payment if you have provided the recommended care
but the patient does not meet guidelines-based care objectives (e.g., blood pressure ≤
130/80 or hemoglobin A1c < 7%).
10. Can I bill for patients covered by other provinces?
Care for patients covered by other provinces who are temporarily in BC is not
eligible for bonus payments as their regular physicians are in another province. If the
patients stay in BC and obtain coverage under the Medical Services Plan then their
care becomes eligible for the program. In a few border communities a BC physician
may provide the majority of care for an Alberta or Yukon patient and care for these
patients is eligible.
11. I have assumed the practice of another general practitioner within the
last 12 months. May I still apply for patients’ chronic disease management
payments?
If the practice you assumed has provided the requisite guidelines-based care to the
patient, you may apply for the chronic disease management payment on its anniversary
date without having to wait a full 12 months from the time you assumed responsibility
for the practice. You may not apply for the chronic disease management fees:
• if a patient did not receive the requisite guidelines-based level of care, or
• a chronic disease management fee has been billed for the patient in the
past 12 months.
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GENERAL PRACTICE BILLING GUIDE