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Professional Standards Regarding Billing


The College endorses the Canadian Medical Association Code of Ethics, which recognizes that physicians must not exploit patients and must use healthcare resources prudently.

Medical care is changing, with more delivery by physicians of publicly uninsured services (hence private medicine) in addition to insured services paid for by the Nova Scotia Medical Services Insurance Program or MSI (hence public medicine).

Whether for private or public medicine, inappropriate billing is recognized by the College as a form of professional misconduct.

When providing private medical services, physicians bear the responsibility to inform their patients about the commercial aspects of the transaction and to deliver services in accordance with the standards of the profession.

When purchasing private medicine, patients bear a responsibility to be informed about the financial risks related to the healthcare they are buying.

Professional Standard(s)

  1. Physicians must be able to demonstrate that any medical service, public or private, was delivered in the patient’s best interest.
  2. Physicians must not charge patients for any services for which they receive compensation by any other means.
  3. Physicians must not bill for undocumented services.
  4. Physicians must maintain clear documentation in support of all billed services in accordance with the College’s Professional Standard Regarding Charting.
  5. Physicians must advise patients of fees for administrative tasks in advance of providing the service. As provided for in the College’s Guidelines for Completing Patient Forms, such fees must be reasonable, consistent, and reflect the time required to complete the form.
  6. Physicians must adhere to the principles of ethical billing set out in MSI’s Physician Manual.
  7. In advance of providing private medical services, physicians must advise patients of the availability of any insured alternatives for the private service being offered.
  8. To obtain informed consent for a private medical service, the physician must advise the patient of all fees or costs associated with the service. This obligation is in addition to the elements of informed consent set out in the College’s Professional Standards and Guidelines Regarding Informed Patient Consent to Treatment.
  9. Physicians must ensure that the costs of clinical investigations ordered in support of private medical services are paid by the patient or incorporated into the cost for the private service. Specifically, it is the responsibility of the physician to ensure that public funds are not spent to pay for investigations, such as blood work or imaging, ordered as part of a private medical procedure.

Document History

As recommended by the Executive of the Provincial Medical Board (now known as the College of Physicians and Surgeons of Nova Scotia): December 22, 1995

 Approved by the Council of the College of Physicians and Surgeons of Nova Scotia: May 27, 2016

This standard replaces Professional Standards Regarding Block Billing and Charging for Uninsured Services and was approved by the Council of the College of Physicians and Surgeons of Nova Scotia: May 25, 2018

Approximate date of next review: 2021