Hospital Care – Tariff 8520

The claiming of hospital care tariffs is governed by Rule of Application 12, which states:

Hospital Care applies to the care of registered bed patients formally admitted to hospital, benefits for which are listed on the Visit Pages, and are claimable from the date of admission to the date of medical discharge by the attending physician. Only one (1) visit per day, per patient, will be paid for in-hospital care regardless of the necessity of multiple visits on the same day. Whenever a visit to an in-patient necessitates a special trip, however, as defined in Rule 3, a Special Call benefit will also apply.

After the date of medical discharge, visits will be claimable on a per visit basis according to the Rules of Application governing chronic care.

Accordingly, the attending physician may claim the hospital care per diem tariff 8520 Hospital care per day for each day of the patient’s hospitalization from the date of admission to the date of discharge.  Subject to substitution noted below, tariff 8520 will be paid for each day of hospitalization regardless of whether or not the attending physician “saw” the patient on any particular day.

During the period of hospitalization, if the patient develops a new problem or their condition deteriorates, the attending physician may need to perform a complete examination or re-examination of the patient.  In these situations it is permissible to claim a different hospital visit tariff e.g., tariff 8540 Complete History and Examination, in lieu of tariff 8520 for that day.  The attending physician resumes claiming tariff 8520 on the following day and thereafter.  For units where in-patient care is provided by rotational coverage, a complete examination may not be substituted for tariff 8520 solely due to the routine changeover of the attending physician, except as noted below.

Billing Notes – Tariff 8520

  • Tariff 8520 may be claimed in addition to the applicable tariff for a complete/regional visit or consultation service on the same day, if the visit or consultation was rendered in the Emergency Room or Outpatient Department prior to the hospital admission.
  • In Manitoba Health recognized clinical teach units (CTUs) only, a complete examination or complete re-examination may be claimed in lieu of tariff 8520 for all patients upon the changeover of the attending physician. Manitoba Health recognizes the following:
    • Medical CTUs HSC (3 units: A4, D4,H4), SBH (2 Units: A & B)
    • Pediatric CTUs: Children’s Hospital (Oak, Elm, Pine)
    • Cardiology CTU SBH
    • Grace Hospital CTU
    • Victoria General Hospital CTU
  • In addition, a CTU attending physician may claim Tariff 8526. See below for further information regarding tariff 8526.
  • When a visit to an in-patient necessitates a special trip, a Special Call (e.g., tariff 8563 or 8567) may be claimed, even if a visit or examination fee is not billable.  If the special trip was provided after hours on an urgent or emergent basis, after hours premiums are also applicable to the special call.
  • After hours premiums may not be claimed in conjunction with tariff 8520.
  • Tariff 8520 may not be claimed during the inclusive post-operative care period for a patient following a major surgical treatment (see website article: Postoperative Period – Transfer of Care ).
  • Alternately funded physicians who provide emergency coverage to Basic A or B ER/OPD facilities, are not entitled to claim tariff 8520 unless specifically permitted to do so in their contract.

Tariff 8526 – CTU Patient Care Supplement – per day

Note:

  1. May be claimed by the CTU attending physician for each patient admitted to a CTU recognized by Manitoba Health
  2. Tariff 8520 and/or other applicable visit/examination services are payable in addition.

Billing Note:

Tariff 8526 is to be billed once per patient per day by the CTU attending physician in addition to Tariff 8520

Questions?

Ian Foster
ifoster@docsmb.org
(204) 985-5854

 

Updated: November 2016