Home Sleep Apnea Testing Frequently Asked Questions
Last updated on July 11, 2024- What is the Medical Services Plan?
- The Medical Services Plan (MSP) is a health insurance program managed by British Columbia’s Medical Services Commission, on behalf of the provincial government that pays for basic, medically required health services, including diagnostics. Approval to bill MSP for the provision of Diagnostic Services is by application to the Advisory Committee on Diagnostic Facilities, a sub-committee of the Medical Services Commission, which is supported by the Ministry of Health’s Diagnostic Services business unit.
- What is diagnostic facility accreditation?
- Accreditation is a formal, independent verification against established standards to assure the quality of the facility and/or service, and to assist in quality improvement. The Diagnostic Accreditation Program (DAP), a program of the College of Physicians and Surgeons of British Columbia, has a mandate and authority derived from section 5 of the College Bylaws under the Health Professions Act, RSBC 1996, c.183, such that every diagnostic facility must be accredited by the committee before it can render a diagnostic service.
- While the achievement of DAP accreditation is a primary condition to bill MSP for services provided, the Ministry of Health has no role in the accreditation process and accreditation does not automatically translate into approval to bill MSP. For more information on the Diagnostic Accreditation Program click here .
- Can HSAT facilities still apply to bill the Medical Services Plan?
- No, effective January 1, 2022 the Medical Services Commission imposed a five-year moratorium on further applications for new, expanded or relocated standalone home sleep apnea testing facilities.
- Can non-accredited facilities offer HSAT for free or at a cost to the patient?
- No. Non-accredited diagnostic facilities cannot operate in B.C.
- Is it possible for an MSP-approved HSAT facility to be purchased? Can a facility’s Certificate of Approval be sold?
- An approved facility can be sold. However, all approvals to bill MSP are site and owner specific, and approval cannot be transferred or assigned. The new owner would need to make a new application for approval to bill MSP and communicate with the DAP to ensure continued accreditation for the purchased company. If sale of an MSP-approved facility is being contemplated, it is recommended the facility operator contact DFadmin@gov.bc.ca for further detail.
- Can a patient be billed for an HSAT if they do not have a B.C. Services Card (i.e., are from outside of the province)?
- Yes, a patient who does not have a valid B.C. Health Care number (e.g., out of province) may be billed for HSAT services. Patients are encouraged to determine if health insurance coverage from their home province is available.
- Can a facility move to another location?
- All Certificates of Approval to bill the Medical Services Plan are site and owner specific. There is currently a moratorium on applications for new, expanded and relocated stand-alone HSAT facilities, as such, requests to relocate a Certificate of Approval will generally not be accepted. However, moves of a minor nature may be considered, as well as relocation required due to extenuating circumstances (e.g., eviction, disaster, etc.). Facility operators are encouraged to contact DFAdmin@gov.bc.ca for further direction.
- Can HSAT done after a patient is on therapy (e.g., to show efficacy of therapy) be billed to MSP?
- Studies that are requisitioned by a physician or nurse practitioner using an appropriately completed and signed requisition form may be billed to MSP.
- Who should MSP billing questions be directed to?
- Facilities approved to bill MSP should direct all billing questions or concerns to Health Insurance B.C. (1-866-456-6950).
- How does an MSP-approved facility change its payment number?
- For billing-related issues such as Teleplan, applying for Data Centres and/or new Payment Numbers, contact Health Insurance BC.
- Once an existing facility has its new payment number via HIBC, an Operational Changes Notification Form must be completed/submitted to DFadmin@gov.bc.ca so that the new payment number can be attached to the current facility number. Failure to do so will result in MSP billing claims being rejected.
Sleep Medicine Update (May 7, 2024)
- Is mobile service provision for HSAT permitted?
- Services performed at locations other than your approved location are not services for which you are eligible to claim payment under MSP.
- Specifically, Section 1 of the Medicare Protection Act (the Act) sets out that the requirement for a service to be a benefit eligible for payment as follows:
- “benefits” means:
- (c) unless determined by the Commission under section 5 not to be benefits, medically required services performed
- (i) in an approved diagnostic facility, and
- (ii) by or under the supervision of an enrolled medical practitioner who is acting
- (A) on request of a person in a prescribed category of persons, or
- (B) in accordance with protocols approved by the Commission.
- Who is to provide services in underserved areas where no HSAT facilities exist?
- In June 2024, the Medical Services Commission approved a change to the Four-Channel Home Polysomnography (Level III, Home Sleep Apnea Testing) policy to address this issue. For details, see the Policies and Guidelines of the Medical Services Commission’s Advisory Committee on Diagnostic Facilities, Section 2.4.3. Assessment Criteria: Service Specific Criteria, Four-Channel Home Polysomnography (Level III, Home Sleep Apnea Testing) at: Policies and Guidelines - Province of British Columbia (gov.bc.ca)
- Can physicians directly bill the interpretation (professional) fee for polysomnography services to the Medical Services Plan (MSP)?
- On January 1, 2002, MSP payment policy was standardized to require all claims for the professional and technical components of services provided at approved diagnostic facilities to be submitted by the facility holding the Certificate of Approval.
- Certificates of Approval to bill the MSP are directly linked to facilities, not physicians. As such, physicians cannot directly bill the MSP for the professional fee.
- This approach to billing the professional fee (and technical fee) through the facility at which the services were provided was established for several reasons including:
- This approach ensures that the services are rendered in diagnostic facilities that are both accredited by the College of Physicians and Surgeons of BC’s Diagnostic Accreditation Program and approved by the Medical Services Commission.
- It ensures that there is both a technical and professional fee performed and submitted to the MSP for each patient. Prior to this billing policy change, when practitioners were permitted to submit the professional fee for select diagnostic services directly to MSP, while the facilities submitted the technical fees, the Ministry of Health identified a major billing anomaly where there was a significant discrepancy between the number of professional and technical fees billed to the MSP .
- There are considerably fewer facilities compared to the number of physicians in BC, as such, this approach reduces the administrative burden required to support the MSP billing system.
- Due to the mobility of physicians within BC, approving diagnostic facilities to bill the MSP, rather than individual physicians, allows for greater consistency/less errors in MSP billing.
- Reference was made to cover letters for final reports being prepared and signed by non- medical staff, whereby summary of data is not allowed. However, can medical health professionals summarize the reports for quick reference for referring physicians, without recommendations and include a disclaimer that the "letter serves as only a summary of the results and has not been reviewed by the interpreting physician"?
- The final report package may be composed of different items including the raw data, interpretation, cover letter etc. Specifically, cover letters are utilized by most facilities to communicate back to the referring physician. These are authored by non-medical staff and the content may include medical information.
- The Diagnostic Accreditation Program’s position on the use of cover letters is that non-medical staff are not to make any recommendations, claims of diagnosis or prescription requests in the cover letter. The purpose of the cover letter can be used to direct the referring physician to the interpretation and clinical findings.
- Can facilities/practitioners provide pre-filled prescriptions?
- No. Please refer to the Diagnostic Accreditation Program’s position statement and communication on prescriptions for HSAT facilities for details:
Prescription Pad Use and Distribution by HSAT Providers (cpsbc.ca)