BC Licensing in Associate Physician and USA Certified Class

BC Licensing in Associate Physician and USA Certified Class—Some questions answered.

Eligibility Requirements
See HPA-Bylaws.pdf (cpsbc.ca) for the College eligibility requirements for registration at
s. 2-25- Associate Physician Acute Care
s. 2-26 Associate Physician Community Primary Care
s. 2-27 USA Certified

We sought clarifications. The College has advised us:
a. that someone registered in this class has the same scope of practice as a RCPSC certified physician but cannot hold themselves out to be RCPSC certified.
b. That physicians licensed in this class must bill under the Family Medicine fee schedule, not the specialist fee schedule.

Our additional questions were directed to CPSBC’s lawyer who responded as follows. Response are in italic:
Bylaws 2-25 and 2-26 Associate Physicians
Bylaws 2-25 (Associate Physician – acute care) and 2-26 (Associate Physician- community primary care)
At this time, we do not have any further information related to section 2-26. As our website states:
“The Ministry of Health is working with the College and health system partners to develop a structure that enables associate physicians to work in community primary care settings. As this is a new classification, considerable planning is required to ensure appropriate and safe integration of associate physicians into community primary care settings. This includes establishing an employment and compensation model as well as a regulatory framework with supporting policies on clinical supervision. It is vital that policies and processes are in place to protect both the health and safety of patients, and ensure associate physicians are supported in their work to deliver quality medical care to British Columbians.

Interested applicants are encouraged to engage with Health Match (HMBC), the free health professional recruitment service funded by the Government of BC. HMBC supports physicians in navigating the pathway to practise medicine in the province. HMBC also guides physicians through the licensing and registration process and matches physicians’ skills and interests to opportunities throughout BC.

Questions:
1. Could you please send me a precedent sponsorship letter that would be satisfactory to the CPSBC?   We will send a template under separate cover.
2. The bylaw provides that the letter must identify the applicant’s sponsor.  Is it correct that the physicians seeking to hire, train, and supervise the prospective associate physician should contact the regional Health Authority for sponsorship and approval? This has not yet been determined as 2-26 is still under development with the Ministry.
3. Can you confirm that “sponsorship” is being used in the broad sense where the Health Authority is not paying for the associate physician but sponsoring in the sense of registering and approving the supervising physician and prospective applicant?  See template letter.
4. Are there other requirements of sponsorship by the Health Authority?  If there are, please specify what they are. It is an employment relationship. See template letter.
5. Does the CPSBC have a list of contact people at each Regional Health Authority for the supervising physicians to contact or do they just contact their local Health office? The College does not have a list of contact people.
6. Out of curiosity, why does the CPSBC require a Health Authority sponsor instead of just a qualified licensed physician sponsor? We are unable to respond as 2-26 is still under development with the Ministry.

Bylaw 2-27 USA Certified
Questions
7. Are we correct that CSAs can now come home and be licensed under 2-27 while they are going through the lengthy certification process, even if they have more than three years of ACGME accredited postgraduate training?  Yes. Generally, the College is seeing applications from physicians who have the three years of training.
8. Are we correct that once these physicians licensed under 2-27 have worked their way through the RCPSC certification process, they can apply for full licensure and upon licensure in the full specialty class will no longer be restricted to the family practice fee billing schedule which the CPSBC advises 2-27 registrants are restricted to? Correct – if found to be eligible for the full or provisional – specialty class.
9. As evidenced by the Health Match BC vacancy list, there is substantial need for specialists in other fields. Where there is a difference in length of training, does the CPSBC anticipate expanding this classification beyond pediatrics, internal medicine, and emergency?  No.
10. If so, when?  See answer above.
11. Of particular interest are psychiatry, anesthesiology, and obstetrics and gynecology where the PGT training is one year shorter.  Are these specialties under consideration for a class similar to 2-27? No

Billing
Many of the items in the fee schedule are the same regardless of whether they are billed under the Family Medicine Fee schedule or whether billed under the fee schedule for the specialist. We sought clarification from Health Insurance BC about billing. We were advised:
“Restrictions on certain Specialist fee codes
While fee items within the Payment Schedule may only appear under certain sections (such as under Family Medicine, or Pediatrics, etc.) that does not necessarily mean that the fee items are restricted to those practitioners that are registered with the CPSBC (and thus with MSP) as that particular specialty.

Most procedures listed within the Payment Schedule are not restricted by specialty, regardless of which section the fee may be listed in. The primary exception to this is diagnostic procedures, which are more likely to be restricted to the section specialty in which they are listed. As an example, Electrocardiogram and interpretation codes 00527 (for office) and 00528 (for home) are restricted to Pediatrics. So there will be services that a pediatrician can bill for, that a Family Medicine specialist cannot.
In addition, the specialist consultation and visit codes that appear within a particular section of the Payment Schedule will be restricted to practitioners of that specialty. So 00510 (Pediatric consultation), or 50507 (Pediatric telehealth subsequent office visit) would be restricted to a practitioner that is registered with MSP as a Pediatrician. The same logic applies to all other sections with the exception of Family Medicine. Fee codes such as 00110, or 00100 are billable by any specialist.

Exemption of specialty restrictions
There may be circumstances where a practitioner wishes to bill for specialty restricted fees. To be able to do so, the practitioner would first need to obtain the approval of the section of medicine that is responsible for the fee item in question. To start this process, the practitioner needs to contact the responsible section through the Doctors of BC. They will be able to provide further guidance on how to apply for an exemption to a specialty restriction.

Rate difference between conceptually similar Specialty fee codes
There will be circumstances where the rate of compensation between different specialties for the same conceptual service differs (ex: 12100 GP office visit age 0-1 @ $34.90 vs 00507 Pediatric subsequent office visit @ $91.04 vs 00307 General Internal Medicine subsequent office visit @ $53.73). The rate at which a fee item is set is done external to MSP and would be handled by the Medical Services Commission at the recommendation of the Doctors of BC and/or the Government of British Columbia. Section C. 2. “Setting and Modification of Fees” (page 1-8) in the MSC Payment Schedule has more information about this.

Ministry of Health – Medical Services Commission Payment Schedule – 01 May 2022.pdf
Associate Physician Classification Payment Schedule and Billing
MSP does not have any information at this time as to whether or not any fee codes, or a broader Payment Schedule, is being developed for associate physicians. Such development would be handled by the Medical Service Commission with the Doctors of BC and the Government of British Columbia.
So long as the associate physician is registered with MSP, they would submit claims for services to MSP using eligible fee codes. This may be done through the Teleplan system, or if eligible, via form HLTH 1915 (details of which may be found here: HLTH 1915 Pay Practitioner Claim (gov.bc.ca))

I hope this has provided the information you were looking for. If there are other questions, please do not hesitate to contact us.
MSP Billing Support can be reached at:
Phone 1-866-456-6950 press option 1, then option 1 again
Fax 250-405-3593

Doctors of BC can be reached at:
Phone 1-800-665-2262
https://www.doctorsofbc.ca/

Billing Support
Health Insurance BC”