The 2019 contract includes a commitment that first-time audits will be primarily for the purposes of education (learn more).
In Nova Scotia, the rules surrounding physician billing are determined by a Fee Committee comprised of representatives from Doctors Nova Scotia (DNS), the provincial government and Nova Scotia Health. Physician services are covered by Medical Services Insurance (MSI) Programs, which are administered by Medavie Blue Cross on behalf of the Nova Scotia government.
The majority of physician services are covered by the Master Agreement, a formal funding contract between physicians and the government of Nova Scotia. Clinical/academic physicians are paid according to the terms of the Master Clinical/Academic Funding Plan (C/AFP) Contract. Some physicians or groups of physicians, particularly family physicians and regional specialists, may choose to negotiate an Alternative Payment Plan (APP) with the government.
In some cases, physicians may do work that is funded by other agencies, such as the Workers’ Compensation Board, or provide non-insured services (such as filling out life insurance forms or providing some immunizations).
The rules surrounding medical billing are complex. Doctors Nova Scotia works with MSI to clarify billing rules and explain new and updated fees.
In cases where physicians feel that fees should be updated, or new fees created, DNS provides support with fee applications.
In some cases, MSI may audit a physician’s billings. Support is available for physicians who have received a pre-payment assessment or a post-payment audit and wish to appeal the results.