A partnership of Doctors of BC and Ministry of Health
Special Bulletin - SSC Fees
Managing SSC Fees
SSC has made various changes to its fees and introduced new ones over the past few years to support specialists delivering high quality care to patients. However, the SSC fees have experienced a higher than anticipate use, which has significantly over-extended the SSC fixed budget. Unlike regular fee-for-service fees funding through the Medical Services Plan, SSC’s budget is capped on an annual basis.
As a collaborative committee with representatives from Doctors of BC, the Ministry of Health and health authorities, we have the responsibility to manage these fees. As such, we are making changes to ensure the fees remain aligned with their original intent while keeping utilization within SSC’s fixed budget. We have worked hard to ensure minimal impact to you while achieving our fiscal goals. The fee changes take effect on July 1, 2017.
Consultation
Once the need to make fee changes became evident, SSC held discussions with section representatives, RACE Line specialists, the Specialists of BC, and other stakeholders. The SSC considered the valuable input from these consultations when it deliberated on how and what to change.
Summary of SSC approved fee changes:
Full details of the fee changes and FAQs will be available on the SSC website when they take effect on July 1, 2017. In the meantime, here is a summary of the changes:
1. Fee items 10001, 10002 and 10005 (Specialist Advice Fees):
a. Urgent Specialist Advice fee (10001) not to be paid if patient was previously seen for the same condition in previous 180 days as the primary purpose of this fee is provide advice on patients that are not your own;
b. Specialist Advice for Patient Management fee (10002) and Specialist Email Advice for Patient Management fee (10005) not to be paid if patient was previously seen for the same condition in previous 30 days as the primary purpose of this fee is provide advice on patients that are not your own.
c. Require physicians who are billing advice fees to include practitioner number of the individual seeking advice for both physicians and/or allied care providers;
2. Fee item 10004 (Multidisciplinary Conferencing for Complex Patients):
a. Reduce fee to the value of the lowest equivalent conferencing fee (approx. $46.23).
b. Require a minimum of 15 minutes per patient to bill 10004
c. Minor fee note changes to clarify that this fee is intended to be used for extraordinary cases rather than for routine care.
Other activities
Group Medical Visits: Before any further fee changes are implemented, SSC will more broadly engage with specialists using Group Medical Visits to better understand how the fee notes can better reflect the key requirements.
Fee Guide: The SSC will look at re-organizing the fee guide to make it user friendly.
Billing Tips
The intent of billing rule changes #1a and #1b (above) is to ensure that the fees are primarily used to provide advice on patients that don’t belong to the specialist who is billing, rather than recurring advice on the same patient. Please note that if the fees are billed more than once within the restricted time periods for the same patient, it must be for a different condition rather than different ICD-9 code. While it’s possible that a general diagnostic code may change to a more specific diagnostic code over time, the underlying condition remains the same and therefore it is only appropriate to bill the fee once within the restricted time period. As with all fees, be sure to document as per the fee notes and bill carefully and appropriately.
If you are unsure about how to bill the fees, you can receive trusted advice from Doctors of BC’s Lea Harth, Fee Guide Assistant lharth@doctorsofbc.ca or call 604-638-2827 or MSP/HIBC Provider Programs 604-456-6950 (Vancouver) or 886-456-6950 (rest of the province).
If you have questions about process taken to make these fee changes, please contact Christina Beck cbeck@doctorsofbc.ca or call 604-638-7858.
We recognize the importance SSC fees have to support specialists in delivering quality patient care, and we will continue to do our best to meet the broad interests of our specialists within our fiscal mandate.
About Us
Physician engagement is the cornerstone of SSC’s work. Formed in 2006 under the Physician Master Agreement to help the Doctors of BC, BC government and health authorities collaborate on the delivery of specialist services and support improvement of the specialist care system in BC.
Sharing your knowledge is important - if you have stories to tell, information to share or feedback to give, please send us an email: sscbc@doctorsofbc.ca