Generally, whenever a physician is requested to assess/treat a patient on an unscheduled/unplanned basis – i.e., the service is not part of the physician’s regular routine and the physician must travel from one location to another to attend the patient (e.g., from the physician’s home to the hospital or office, from the office to a personal care home, from one hospital to another hospital that is not in the same building complex, etc.) a Special Call may be applicable.
The Physician’s Manual defines a Special Call under Rule of Application #3 and on page B-3 as follows:
Whenever a physician is required to make a special trip, over and above the physician’s regular routine, to attend a patient, a Special Call benefit may be claimed in addition to the benefits listed for assessment and/or procedural medical services (except as listed below). Only one (1) Special Call per response is applicable.
A Special Call must be initiated by someone other than the physician (except when services are rendered outside the hospital) and requires the physician to travel from one location to another (not within the same building complex) to attend the patient.
A Special Call benefit will be paid even if the patient is deceased, on the arrival of the physician called, or, if the patient has left the premises prior to the physician’s arrival provided the physician was not unreasonably tardy.
Subject to the Exclusions listed below, all Special Call benefits may be claimed under the following tariffs:
|8561||For special calls made to a patient’s home||$41.85|
|8598||For special calls made to the emergency department or O.P.D. of a hospital||$53.25|
|8566||For special calls in obstetrics||$53.25|
|8567||For special calls made in non-elective surgical cases, in the postoperative period||$53.25|
|8563||All other special calls not covered under Tariffs 8561, 8566, 8567 or 8598 (including, but not limited to, special calls made to personal care homes and to attend to registered hospital patients, subject to Exclusion (a) below) may be claimed under this tariff||$53.25|
Special Call benefits do not apply under the following circumstances:
- Care to registered hospital patients during the physician’s regular daily round.
- Regularly scheduled daily office appointments.
- Scheduled N.F.A. medical services.
- Routine care provided to patients in personal care homes.
- Scheduled routine in-patient surgical activity.
- Where the physician is already in the hospital.
- All elective surgery both pre and postoperative.
- In obstetrical care, on the day of delivery, by the physician performing the delivery or the elective caesarean section.
A special call may not be claimed:
Provided the other elements of the special call are met, a special call shall be paid in the following circumstances:
After Hours Premiums
Where the special call is rendered in conjunction with an urgent/emergent service in an after hours time period, After Hours Premiums apply to the special call fee, in addition to the fees for the other services provided.
Multiple Special Calls Same Day
Where the physician has been called back to a location, departed and thereafter requested to return to the same location another special call may be claimed. For audit purposes, it is recommended that you note in the chart the person making the request and time you returned for each subsequent special call claimed on that day. Where the second or subsequent special call is for the same patient, a remark specifying the time of each of the special call services should be included with your claim.
Updated: April 2018