Rule of Application #1 (Call or Examination) is an important, and often overlooked Rule in the Physician’s Manual. This rule permits a physician to claim a visit fee where a patient’s situation requires a separate visit by a third party. A claim may be made provided the following criteria are met:
- “exceptional circumstances” exist, and
- the visit with the third party has been arranged by formal appointment and lasts a minimum of 15 minutes.
Claiming an additional visit fee may be a good option where a third party visit does not meet the criteria of either Tariff 8474 (Case Management Conference) or Tariff 8473 (Patient Care Family Conference).
Claims should be submitted By Report, with a brief explanation as to the necessity for the third party visit.
- This Rule does not prescribe which particular visit fee should be claimed for meetings with third parties.Doctors Manitoba recommends that you exercise your discretion as to which is the most appropriate visit tariff to be claimed. In so doing, you may wish to take into account such factors as the amount of time spent with the third party and what tariff number was billed in relation to your most recent visit with the patient involved (as you may wish to submit a claim for the third party visit under that same tariff number).
- The visit with the third party does not have to comply with the provisions/rules associated with the particular visit tariff claimed.For example, if the visit fee that is claimed in respect to the third party visit is a Complete History and Physical Examination, it would obviously not be required for you to perform a physical examination of the third party.
- Ensure the visit is well documented in the patient’s chart.
Updated: November 2016