Alternate-funded MDs: Can you ever bill fee-for-service?

Under many alternate funded contracts, full-time physicians will be paid to provide 40 hours of medical services per week. As frequently happens, however, physicians work more than 40 hours per week.  The question becomes: How are physicians who are subject to one of these alt-funded contracts paid when they provide medical services in excess of 40 hours per week?

As a general rule, where a physician is providing medical services in excess of 40 hours per week/8 hours per day (and is NOT on-call at a Basic A or B emergency room or a personal care home) the physician will be compensated at the regular hourly rate stated in their contract.  A few examples of when this applies are as follows:

  • As a result of providing medically necessary services the physician is required to remain at the clinic/hospital beyond his/her normal office hours.
  • The physician is called by a nurse or allied health care worker with regard to one of his/her own patients and the physician determines it is necessary to attend to the hospital/personal care home to examine that patient.
  • The physician is part of an on-call rota approved by the RHA and is called by a nurse or allied health care worker and the physician determines it is necessary to attend to the hospital/personal care home to examine that patient. (Note: this does not apply where the physician is providing on-call services pursuant to the Personal Care Home On-Call Agreement).
  • The physician agrees to conduct an evening or weekend clinic.
  • The physician attends the hospital on a weekend or designated holiday and conducts rounds.

When can alternate-funded physicians bill fee-for-service?

There are several circumstances where a physician is entitled to bill fee-for-service when providing services outside of their normal office hours. These include:

  • Where a physician provides unscheduled obstetrical services;
  • Where a physician is providing on-call services pursuant to the Personal Care Home On-Call Agreement (see Personal Care Home After-Hours On-Call Coverage); and
  • Where a physician is providing on-call services pursuant to the Basic A & B  ER Agreement.

In the case of Basic A& B ER coverage, when the physician is receiving the on-call per diem the following rules apply:

  • During the physician’s normal office hours of work the physician shall receive his/her regular hourly rate and may not bill fee-for-service.
  • In accordance with the Basic A & B ER Agreement the physician may bill fee-for-service during the physician’s billing window (12 hours on weekdays and 24 hours on Saturday, Sunday and general holidays) for hours that fall outside of normal office hours.
  • Where the physician completes rounds on a Saturday, Sunday or general holiday and has provided 40 hours of medical services that week, the physician shall be paid his/her hourly rate in addition to the daily stipend.

It is important to remember that a physician may not, at any time, bill fee-for-service while at the same time receiving the hourly rate under his/her contract and/or counting those hours towards their 40-hour per week contractual obligation.

Note: Alternate-funded physicians may not, under any circumstances, bill tariff 8520 (Hospital Care).

Questions?

Roger Jamieson
rjamieson@docsmb.org
(204) 985-5849

Updated: November 2016