Billing Two Different Payor Agencies for a Single Office Visit
Is it appropriate, and when?
The Claims Submission and Payment Procedures section of the Physician’s Manual states:
“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, Doctors Manitoba offers the following example where the physician provides two distinct services and bills two agencies:
Suppose a WCB patient regularly visits for opioid management for chronic pain in conjunction with a WCB claim. However, at the latest visit, the patient also complained of stomach pain and was assessed for possible diverticulitis.
In this case, the physician would not ignore the new complaint or make an appointment for a few weeks later, the physician would address both complaints and then bill both Manitoba Health and the WCB.
If the physician is uncertain, they may wish to contact Manitoba Health or Doctors Manitoba to obtain billing advice before submitting such a claim.