On-Call Coverage of Basic A/Basic B or Like Facility – Fee-for-service Claims

This article is applicable to all physicians who provide on-call coverage of the emergency and/or out-patient departments of:

  • “Basic A” and “Basic B” hospitals;
  • Gillam Hospital, Lynn Lake Hospital, Leaf Rapids Health Centre and Snow Lake Health Centre; and
  • the communities of Hodgson, Churchill or Norway House and are contracted by the University of Manitoba, J.A. Hildes Northern Medical Unit (NMU).

The Agreements under which these physicians are compensated provide the physicians with a daily stipend for all days on-call and the right to submit fee-for-service claims for certain services during their on call-period.

Services cannot be claimed by an independent contractor or salaried physician during their normal contract hours.  Fee-for-service physicians on-call and other physicians on-call outside of their normal contract hours, may bill fee-for-service for the following services:

  1. all obstetrical, surgical* and anaesthetic procedures provided in the hospital at any time during the on-call period; and
  2. all medical services (including claims for Special Calls and After Hours Premiums) provided in the hospital during a period of twelve consecutive hours each weekday;(The period of twelve consecutive hours is commonly referred to as the “Billing Window“.  A physician may determine his/her own Billing Window in consultation with the RHA. )and
  3. all medical services (including claims for Special Calls and After Hours Premiums) provided in the hospital anytime on Saturdays, Sundays and general holidays.

* “Surgical procedures” include, but are not limited to services billed under tariff #0250 (Wound repair, multiple), and services billed under tariff #0256 (Foreign body subcutaneous tissue, removal, complicated), but excludes tariffs #0130 (Foreign body subcutaneous tissue, removal, simple), tariff #0251 (Wound repair, simple, any location), tariff # 0852 (Fractures: Upper extremity, Phalanges, fingers or thumbs, closed reduction), and tariff #0980 (Fracture: Lower extremity, Phalanges, closed reduction).

Billing Notes:

I am a fee-for-service practitioner and my weekday Billing Window is from 9:00 a.m. to 9:00 p.m.  I agree to provide on-call coverage from 9:00 a.m. Friday until 9:00 a.m. Saturday.  When am I able to bill fee-for-service?  You are eligible to submit fee-for-service claims for services provided from 9:00 a.m. Friday until 9:00 p.m. Friday evening as well as from 12:00 a.m. to 9:00 a.m. on Saturday.  You are not eligible to submit fee-for-service claims for services provided from 9:00 p.m. Friday to Midnight Friday, except for obstetrical, anesthetic and eligible surgical services.

When/how do After Hours Premiums applyIf the service was eligible to be claimed on a fee-for-service basis (i.e. the service was provided during your Billing Window or was an obstetrical, anesthetic and eligible surgical service), After Hours Premiums will apply to any urgent or emergent service, when that service was provided during one of the after hours periods set out at page B-1 of thePhysician’s Manual, and where all other requirements of the tariffs are complied with. After Hours Premiums

During my Billing Window I am called back to the hospital to attend a patient in the ER.  While still at the hospital another patient presents at the ER that requires my attention. Can I claim a Special Call?  A Special Call (tariff 8598) may be claimed for the first patient.  A Special Call may not be claimed for second or subsequent patients that you see after you have arrived at a location.  Special Calls

A nurse phones me during my Billing Window regarding a patient presenting to the ER.  I am able to manage the situation by telephone. Can I claim tariff 8000?  Generally, no. Tariff 8000, Communication with an Allied Health Professional, is claimable only for certain categories of patients as set out on page B-6 of the Physician’s Manual.

Questions?

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

 

 

Updated: December 2016