Billing Two Different Payor Agencies for a Single Office Visit

Is it appropriate and when?

Consider the following excerpt from the Claims Submission and Payment Procedures section of the Physician’s Manual:

PART I—BILLING AND PROVISION OF SERVICES

4. Physicians should exercise care when billing multiple agencies (e.g. Manitoba Health and another agency such as an insurance company, or the Workers Compensation Board of Manitoba) for multiple services provided during the same visit. Generally two agencies may not be billed for the same service claim.

However, we offer the following example in cases where two distinct services are provided in a single visit where it would be appropriate to bill both agencies:

WCB patient visits regularly for opioid management for chronic pain in conjunction with a WCB claim. However at the latest visit, patient also makes complaint about stomach pain and is assessed for possible diverticulitis. Physician would not ignore the new complaint or make an appointment for a few weeks later. Physician addresses both complaints and both Manitoba Health and the WCB are billed.

If the physician is uncertain he/she may wish to contact Manitoba Health and/or Doctors Manitoba to obtain billing advice before submitting such a claim.

Questions?

Braden Kalichuk
bkalichuk@docsmb.org
(204) 985-5848