The Claims Processing System

The Claims Processing System is comprised of four major sequential components. What is the order and when do they run? (4 marks) 2. What is a duplicate billing? When can you bill a duplicate visit? When can you not? What information is required on the bill in order for MSP to approved it? (4 marks) 3.

Who is responsible for setting the fee codes listed in the MSC Payment Schedule? (1 mark) 4. Differentiate between “Fee Code” and “Diagnostic Code/ICD9 Code”. (2 marks) 5. How long from the date of service does a physician have to submit a claim to MSP? (1 mark)

6. What are submission codes? Differentiate between the different codes available and when they are used. (5 marks)

7. What is a referral? How does a physician refer a patient to another physician? (2 marks) 8. What are daily volume limits? (1 mark) 9. How long must a physician retain records on a patient? (1 mark) 10. What is a no-charge referral?

Why is it important that one be charged? (2 marks) 11. What are explanatory codes? (1 mark)   12. What is counselling defined as? What limitations are there? (2 marks) 13. What is the process for billing for a newborn without a PHN? (1 mark) 14. What is an uninsured service? (1 mark) 15. Delivery and Post-Natal Care is charged when a patient delivers a newborn baby.

How long is the patient covered under the fee code while in hospital? What do we charge for the baby? How long is the coverage for the newborn under that fee code? (3 marks)

16. How many GP Telephone/Email follow-up management fees are physicians allowed to bill for in a calendar year as permitted under the Chronic Disease Management Incentive Program?

What is the purpose of being able to bill these fees? (2 marks) 17. What is reciprocal billing? Who participates in it? (2 marks)

18. Differentiate between balance billing, differential billing, and extra billing. (3 marks) 19. What are supportive care fees? What is the limitation on billing for them? (2 marks)

20. What is a consultation? What does it include? (2 marks) 21. How do you bill when a patient has multiple procedures done at the same time? (1 mark) 22. What do fee items that are operation only include? (1 mark) 23. What is required for a patient who is under continuous care by a consultant? (1 mark)

24. If a patient visits the office for a car-accident related injury, who is responsible for payment? What if the car-accident injury was work-related? (2 marks) 25. If a patient visits the office for a work-related injury who is responsible for the bill? (1 mark)