Family Medicine Plus only applies to longitudinal practice, in which physicians become the most responsible provider (MRP) for patients who agree to be enrolled on their panel. It does not apply to episodic or walk-in visits for patients outside of a physician’s enrolled panel.
Q&A
FAQ
Does the Family Medicine Plus model apply to physicians who decide to stay with episodic/walk-in care as their practice model?
What happens if another clinic/practitioner enrolls a patient who is already enrolled in my practice?
The decision to engage in patient enrollment is significant for both the patient and the clinic. Physicians and clinics are expected to take enrollment seriously and professionally. As the Most Responsible Provider (MRP), along with the clinic (known as the Home Clinic) they will be responsible for providing ongoing, continuous, comprehensive care. All relevant labs and information related to the patient will be sent to the patient’s clinic. Further, an enrollment conversation should include asking if the patient already has a family physician and should confirm they no longer wish to receive care from their existing provider. The Home Clinic team can provide resources to address these discussions.
Is there a minimum number of visits, hours or days per week that must be worked to claim the weekly indirect clinical services tariff?
To claim indirect clinical services in a given week, you must provide patient care to enrolled panel patients during that week. This includes in-person or virtual visits, or prescription renewals. If you are away on vacation, CPD, or other activities which exclude you from providing patient care during a given week, you may not claim for indirect clinical service time. Beyond this, there is no requirement with regard to hours or days during the week
With disease clusters claimable on a quarterly basis, do I have to wait until the next quarter to claim a disease cluster payment for a new patient or a patient with a newly diagnosed condition?
As long as the patient is enrolled and has received a medical service from you in the preceding 24 months, you can claim the new medical and/or mental health cluster during this quarter, and then again in the next quarter. In all cases, claiming a cluster will mean the patient is no longer eligible for a CCM tariff.
This could mean claiming a cluster in June for the April to June quarter, and then again in July for the July to September quarter.
Can FM+ be claimed annually or only quarterly?
FM+ is billed quarterly to provide more steady, predictable funding to support your practice. You will receive claim rejections if you attempt to bill for multiple quarters simultaneously.
For billing three clusters in FM+, do three ICD codes need to be sent?
No. We have confirmed with Manitoba Health that they are looking for only one applicable ICD code to process your FM+ disease cluster claims. However, it will be expected that the diagnoses are in your chart, and ICD codes are reflected in your patient “problem list.”
How long does a patient need to be on your panel in order to bill?
Patients can be billed under panel payments the day after successful enrollment. FM+ remunerates for the care you may provide over the course of the following quarter, on a prospective basis. So, there is no time requirement for the patient to have been on your panel. This is different from CCM tariffs, which you claimed at the end of the year, retrospectively.
Is the newborn tariff only available for brand new newborns or infants enrolled in my panel?
You may bill for any and all infants or newborns enrolled on your panel who are still under the age of 2 on April 1, 2024. Going forward, you can also claim this for all patients <24 months you successfully enroll in your practice.
Transition Questions:
I completed some CCM billings last month (March 2024), can I bill for FM+ for those patients April 1st?
Yes! We recommend that if you have submitted CCM within the time period of January to March that you bill all elements of FM+, including medical and mental health disease cluster payments, April 1st.
My anniversary date for CCM is in The April-June quarter, when do I start my cluster payments?
We recommend you complete your final CCM payment, as well as claim age-based panel payments, indirect time and newborn enrollment. Then, you can begin to claim your medical and mental health disease cluster payments in the next quarter (July-September).
My anniversary date for CCM is in The June-September quarter, when do I start my cluster payments?
We recommend you complete your final CCM payment as scheduled, as well as start claiming age-based panel payments, indirect time and newborn enrollment in April. Then, you can begin to claim your medical and mental health disease cluster payments in the next quarter (October-December). There may be certain patients for whom it would be beneficial to immediately start on FM+, you may make these decisions on a case-by-case basis.
My anniversary date for CCM is in The October-December quarter, when do I start my cluster payments?
We recommend you forgo your CCM payment and begin all elements of Family Medicine Plus on April 1st, including the medical and mental health disease cluster payments.
Last updated
March 26, 2024