Physicians who are licensed by the College of Physicians and Surgeons of British Columbia (CPSBC) are eligible to enrol with the Medical Services Plan (MSP) and obtain MSP billing numbers.
Enrolment status, and, therefore, the possession of an active billing number, is contingent upon the practitioner's continued licensure by the CPSBC. Any change in licensure, such as the renewal of a temporary license or specialty, must be reported to MSP to avoid refusal of claims.
A physician may be:
- enrolled with MSP (if licensed with CPSBC)) – note that almost all physicians in BC fall in to this category;
- once enrolled, opt out of MSP;
- once enrolled, de-enrol from MSP (cancel the enrolment) – either voluntarily or by order of the Medical Services Commission; or
- not enrolled with MSP.
Licensed physicians who register with MSP are called "enrolled" physicians. Enrolled physicians may choose to be "opted-in" or "opted-out".
Opted-in physicians are physicians who are enrolled in MSP under Section 13 of the Medicare Protection Act and who elect to bill MSP directly for insured services provided to MSP beneficiaries. An opted in physician may not bill a patient directly for an insured benefit.
Opted-out physicians are physicians who are enrolled in MSP under Section 13 of the Medicare Protection Act and who elect to bill patients directly for insured benefits. The patient may then claim reimbursement from MSP. By law, an opted-out physician may not charge a patient more for an insured benefit than the prescribed MSP amount.
Physicians Who Are Not Enrolled/De-enrolled
Not enrolled/De-enrolled physicians are not registered with MSP. Consequently, services provided by a physician who is not enrolled/de-enrolled are not insured and beneficiaries are not eligible for reimbursement by MSP. By law, not enrolled/de-enrolled physicians in B.C. may not charge beneficiaries more than the MSP amount for an insured benefit, if the service is provided at a facility defined by legislation (e.g., hospital or community care facility). When a service is provided outside of the facilities defined by legislation, the amount that may be charged to a beneficiary is not limited by the MPA and beneficiaries are not eligible for reimbursement by MSP.
In order to de-enroll, the physician must give the Medical Services Commission 30 days written notice of their intent to de-enrol. Once de-enrolled, the physician may not apply for enrolment within 12 months of the de-enrollment unless the Medical Services Commission considers this to be in the public interest to allow the application.
Note: The prohibition of extra-billing for medical services does not apply to uninsured services such as cosmetic surgery, third-party medical services, etc. The charges for these uninsured services, including related pre-operative and post-operative visits, are to be paid by the beneficiary. These fees are not eligible for reimbursement by MSP.
If a not enrolled/de-enrolled physician intends to require their patients to pay all or a portion of the costs of a service, they must inform the patient, prior to rendering the service:
- that the patient will be required to pay part or all of the cost directly;
- the amount the patient will be required to pay; and
- the amount the patient can expect to be reimbursed by MSP (if any).
If a physician does not meet the notice requirement the patient is not liable for payment to the physician and the patient may be entitled to a refund.
Assignment of a Billing Number
Each practitioner enrolled with MSP is assigned a billing number consisting of two numbers:
- a practitioner number, which identifies the practitioner rendering the service; and
- a payment number, which identifies the person or group (e.g. clinic, hospital) to which payment is to be made.
The practitioner and payment numbers are usually the same. However, they differ in cases where a practitioner designates another practitioner or a group, such as a clinic or hospital, to receive that practitioner's MSP fee-for-service payments.
All claims submitted to MSP must include the practitioner number of the practitioner who performed the service; therefore, a practitioner cannot bill under another practitioner's number. The practitioner whose number appears on the MSP claim assumes full responsibility for the service provided.
Applying for a Billing Number
Physicians wishing to obtain a billing number from MSP must follow a clearly defined process.
1. You must first request licensure from the College of Physicians and Surgeons of BC.
2. You must complete and submit the following application form:
Change of Address or Licence
If you change your address or telephone number, or if there is a change in your specialty or licence status, you must advise MSP so that your records can be updated accordingly. Timely notification of changes enables MSP to provide practitioners with accurate and efficient service and helps prevent unnecessary refusal of claims.