Billing FAQs
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Q: I am a physician providing sessional services. What do I need to know about billing?
Q: What are the 2022 cut off dates for paper and electronic claims?
A: Payment Schedule 2024 | Payment Schedule 2025
Q: How long do I have to submit a claim?
A: Claims must be submitted within 90 days of the date of service; unless MSI is of the opinion the delay is justified. Resubmission of refused service encounters must be within 185 days of the date of service. The only exception to this policy will be through special consideration in exceptional extenuating circumstances.
Q: What do I do if I have outdated claims that I need to submit?
A: Please send a written request to the Team Leader of MSI Programs, including your name, provider number, date(s) of service, the number of outdated claims, and the reason for the delay.
Q: Can I claim for phone calls I make to my patients regarding follow up to blood work, X-rays, ultrasounds etc?
A: No, this is not an insured service.
Q: Does MSI issue T4 statements to physicians?
A: No. You can obtain a statement of earnings from our MSI Health Information department for a fee. Please inquire by sending a fax to 902-469-4636 or email to [email protected]
Q: I am a specialist and my recent claim for a prolonged consultation was refused. I was told that I needed to submit text indicating the start and stop times of my encounter with the patient. Is this something new?
A: There has been a longstanding requirement for physicians to record start and stop times directly on the patient record for all time based fees, such as prolonged consultations and counselling/psychotherapy services. Reminders of this requirement are sent to physicians annually in MSI Bulletins. Lack of start and stop times has been a significant issue when these services are audited and since December of 2012, all time based services must contain text indicating the start and stop time with the patient. It was felt that this requirement would serve as an extra reminder to physicians of the existing Preamble rule.
Q: I am a psychiatrist who provides psychotherapy. Generally, my sessions with my patient last 50-55 minutes and after they leave I spend a few minutes completing my chart note. What time should I record?
A: Record the start and finish of your face to face time with your patient as this is the time that is the basis for payment.
Q: Since my billing clerk is now recording times on the electronic claim, am I still required to record them on the patient chart?
A: The Preamble requirement to record start and finish times directly on the patient record has not changed so you need to continue to do this.
Q: Speaking of time-based services, I was considering hiring a nurse practitioner for my family practice to do lifestyle counselling. If I see the patient for a few minutes at the end of the counselling session that the nurse does, may I claim for lifestyle counselling?
A: The Preamble requires that the physician claiming the service spend at least 80% of the time claimed directly with the patient. This means that you may not claim for lifestyle counselling unless you have personally done the counselling.
Q: A colleague and I were chatting and he thinks he might be able to claim lifestyle counselling if he plays a video for patients on a wellness topic while they wait to see him. I disagree. Who is right?
A: You are correct. Since counselling and psychotherapy services require the physician to spend at least 80% of the claimed time directly with the patient, he would not be able to claim for this.
Q: I run a clinic whose primary purpose is the provision of uninsured services. The treatments we provide are alternative or cosmetic and patients pay us directly. If I discover a serious issue that requires a traditional medical approach, may I claim for this service?
A: If the primary purpose of the patient’s visit to you was to receive an uninsured service such as an alternative therapy or cosmetic procedure, you may claim for other services in very limited circumstances:
- the medical issue must be completely unrelated to the reason for the visit to your clinic; and
- the medical issue is of a serious nature.
For example, if a patient attends your clinic for alternative therapy for back pain, you would not be able to claim for prescribing medication or providing lifestyle counselling related to the back pain as this is related to the reason for the visit. It would also not be appropriate to claim for assessing a minor health concern such as a cold or minor infection but it would be reasonable to claim for assessment of a serious issue such as suspected acute coronary syndrome.
Q: I am a surgeon who was asked to see a patient in the Emergency Department. The patient had had an experimental procedure done in another country and developed a serious wound infection when she returned to Canada. May I bill MSI for seeing her?
A: Yes, if a patient develops complications after receiving an uninsured service, you may claim for your treatment.
Q: Where do I find diagnostic codes?
A: The diagnostic codes can be found here