MSP to Cover Acupuncture in BC

AcuGuru

I am wondering how good of coverage this really is ? has anyone had experience with this type of billing ?

I am really happy that acupuncture is being recognized for coverage.

I have talked to some Chiropractors and they have mentioned having many problems with billing through MSP, some even do not bill through them as the time it takes and the payments recieved are not worth the time.

- They say 10 visits, is that solely for acupuncture or are we placed in the same group as Chiro, massage, physio, ...
- If our fee's are 50$ per visit, we would bill the patient $37 and submit to MSP for the other $23 ?
- it's covered under "diagnosed" conditions, diagnosed by ? .... us, MD, .... do the patients need to be referred to us ? how do we provide adequate information to MSP to have our patients covered ?

I have lots of questions, if anyone has answers please pass it along

Thanks all, it will be interesting to see how this come out for us TCM'ers

Seems like a step in the right direction. It may not be perfect coverage, but baby steps.

if a patient is low income ($28,000/year or less - you can find out by their care card) then they qualify for assistance.

You are right, if you charge $50, the client is charged $37 and you bill MSP the discounted $23. It is a finniky system, but it helps those who may not be able to come for the treatment to see if it works. You have to make sure there is an ICD9 code and someother code... don't remember off the top of my head. The ICD9 code is what you are treating them for. I don't know about a referral, but you may be able to find more about it on the government's MSP site.

It is a step in the right direction for TCMers!! Hope this helps a little

not to be a math nazi, but if you charge $50, the client would pay *$27*, not $37.

Perhaps I can be of assistance and shed some light on this. You will need the basic patient data as carried on the care card - name as is appears on the care card, date of birth, sex, province of residence & phn number. For the claim info, you'll need date of service, a fee code that applies an amount for the service provided (there will likely only be a few you'll need to know), and the icd9 code. Referral practitioner is not likely to be necessary, as it isn't with other supplemental benefit providers (chiro's, rmt's, physios, etc.).
Our company, www.mediclaim.ca, provides a browser based billing program in wide use with chiro's, rmt's, midwives, as well as hundreds of md's/specialists. No software required, and it can be accessed by any online computer. It allows a practitioner to enter and store patient data, submit claims to msp in a few easy steps, and track submissions and payments from msp. If a referral practitioner is required, a complete MD database is available for users to easily find and enter referral practitioner info. Full training and support is provided and it's quite inexpensive. Hope this helps.

"maximum combined 10 visits of supplementary benefits"
what is this mean? 10 visits per year? 10 visits per sickness?

What I discovered when I spoke to a claims person in Victoria, is that it is 10 total visits to any 'alternative' practitioner: e.g. naturopath, PT, acupuncturist, etc.. In my opinion, that isn't very conducive to the patient, especially as acupuncturists, we know that more often than not, one visit just doesn't cut it for anything.

I spoke to a rep. in Victoria today about these things. Unfortunately, they weren't too helpful overall, however did clear up one thing - the options to either opt in or opt on need to be defined better. I discovered that 'opt in' means that while the patient pays $0, the practitioner can only bill MSP $23, no matter what. 'Opt out' is where you bill MSP the $23, and the patient pays the remainder of your fee upfront. Unless you are someone who sees patients every 15-20 min. and can justify $23 in that timeframe, no wonder most naturopaths, RMT, etc. that I know have opted out.

I asked them if there were any safeguards around patients defrauding, etc. For example, how would I know if someone had not already used up their 10, came in, presented their cards info, etc. and I went ahead and billed MSP, only to find out that I couldn't collect my $23. I was told there was an automated phone number to call, we would have to input their care card#, birth month and year, and essentially be told how many usages this patient had or still had. The problem the way I see it is that we can only do this AFTER the patient has already arrived for the appt. since that is when they present the card card info. We are then faced with the possibility of informing the patient that they do not qualify, assuming they have used up their visits, and therefore have to pay your full fee upfront.

As for the Teleplan billing, again, Victoria didn't provide me with any names of companies who do it, but perhaps there are some reputable ones out there. If anyone knows of good ones, please let me know.

You can verify patients' eligibility before treatment with our MSP billing software Claim Manager TCM. Three pieces of information required are PHN, Date of Birth and Date of Service. After you hit Verify button, you receive an instant message from Teleplan saying how many visits are left on the date of service.

Claim Manager TCM is developed specifically for BC acupuncturists. It is simple, simple, simple. And inexpensive. Right now we have a free 3 months trial that expires June 30. Visit www.tripletee.com for more info and request our brochure with prices.

Bill MSP for free for 3 months and decide for yourself if we are reputable enough :)

TripleTee Software Company
Techie Tools for Therapists
www.tripletee.com