Indirect Clinical Services
In addition to panel payments, Family Medicine Plus also offers family physicians remuneration for up to three hours of indirect clinical services per week. This recognizes the various indirect tasks physicians provide to support patient care, such as documentation, reviewing results, preparing referrals and requisitions, and care coordination among others.
Rather than adding a new administrative burden of tracking your indirect clinical time, the billing claim for indirect clinical services is a simple multiplier based on your panel size:
- Physicians receive up to 30 minutes per week for every 250 patients enrolled in their panel.
- Indirect clinical service is claimed in 15-minute units.
- Physicians can claim up to three hours, or up to 12 15-minute units, with a panel of 1,500 patients or more.
- Indirect clinical services should be claimed weekly. It can only be claimed during weeks the physician has provided primary care services to their panel.
The following table summarizes what can be claimed based on panel size.
| Enrolled Panel Size | Maximum Units (15 minutes each) | Maximum Hours Per Week | Maximum Payment Per Week |
|---|---|---|---|
| less than 250 | 0 hours | ||
| 250 to 499 | 2 | 0.5 hours | $85.52 |
| 500 to 749 | 4 | 1.0 hours | $171.04 |
| 750 to 999 | 6 | 1.5 hours | $256.56 |
| 1,000 to 1,249 | 8 | 2.0 hours | $342.08 |
| 1,250 to 1,499 | 10 | 2.5 hours | $427.60 |
| 1,500+ | 12 | 3.0 hours | $513.12 |
Claiming Indirect Clinical Services
A single tariff is used with a generic PHIN to claim indirect clinical services. Review the tariff below. You can expand the box for billing notes.
8191
Indirect clinical services provided to the physician's enrolled panel of patients, to a maximum of 12 units per week, subject to the below maximum.
$42.76 Per 15 Minutes Per Week
Notes:
1. The physician may claim up to 30 minutes per calendar week, for each 250 patients on their panel. A calendar week is defined as Sunday to Saturday
Example, a physician with an enrolled panel of 1,300 patients shall be eligible for:
1,300 / 250 = 5.2 = 5 30-minute blocks, or 10 units of 8191 per calendar week.
2. The physician shall be limited to a maximum of three (3) hours (or 12 units) of indirect clinical service per calendar week.
3. The physician shall have provided primary care services to their enrolled panel of patients during the calendar week that they are claiming indirect clinical services.
4. The physician may claim for time spent on indirect clinical services, which are patient-specific services provided when the patient is not present. This includes:
i) Documentation of patient interactions and charting.
ii) Review of results: labs, imaging, consultations, and other reports.
iii) Preparing referrals and requisitions, excluding e‑consultation.
iv) Chart review.
v) Care coordination, and care planning.
vi) Clinical teaching arising from direct patient care for the following learners: medical students, residents, nurses/nursing students, nurse practitioners/nurse practitioner students and midwives/midwifery students
vii) Reviewing and analyzing clinically related information/research directly related to the needs of a particular patient (e.g. investigating particular diagnostic and therapeutic interventions)
viii) Completion of clinically required forms, reports and medical certificates of death. This excludes services requested or required by a third party for other than medical requirements, such as insurance forms and reports, medical-legal letters and reports, insurance/industrial
The claim will have to reference the week of service but does not have to be claimed in that week. For example:
Week ending April 6th
Week ending April 13th
Week ending April 20th
Week ending April 27th
These services could all be claimed at the end of the month on single claim denoting tariff 8191 the number of units each week and the weeks on 4 separate claim lines.
There must be a record of the number of patients on your enrolled panel, and a brief description of the types of services provided for indirect clinical services. This does not need to be documented at a patient specific level of detail.
Claim Instructions
When billing, use the following GENERIC patient demographics to ensure your billings are not rejected:
| Field | Input |
|---|---|
| Registration Number | A40905 |
| PHIN | 126869933 |
| First Name | Indirect |
| Surname | Services |
| DOB | April 1, 2000 |
| Gender | F |
When can’t you claim indirect clinical services?
Indirect clinical services are payable provided that the claiming physician provided medical services to their enrolled panel of patients in that given week. This means the following weeks are not eligible for indirect clinical services, unless you provided a visit or procedure to patients on your panel during the week: vacation/holiday weeks, exclusively on a service that is not primary care (Hospital or walk in), were on CME leave, etc.
Indirect Clinical Services cannot be transferred between physicians in group practices, which means if you are covering a colleague’s panel during their time away, you cannot claim additional indirect clinical services.
Do I need to track my indirect clinical time?
No. As we focus on reducing administrative burdens for physicians, Manitoba Health agreed to a model that is based on panel size. It is understood some physicians save indirect clinical work for the end of the day or a paperwork afternoon, while others complete tasks throughout the day.
What if I spend more than the maximum three hours per week on indirect clinical time?
Manitoba Health would likely suggest some indirect clinical services are remunerated as part of the visit or procedure tariff. Doctors Manitoba advocated for remuneration for clinical time because administrative tasks have become more complex and demanding. Our research shows physicians spend over 10 hours per week on administrative tasks. Manitoba Health set the maximum time claimable under FM+ at three hours per week. Doctors Manitoba will monitor physicians’ experiences under FM+ closely.