Many family physicians have been claiming Comprehensive Care Management (CCM) tariffs for several years. This article provides guidance on how to submit your final CCM claim and begin claiming Family Medicine Plus (FM+) tariffs. 

First, it’s important to understand the basics:

• CCM was claimed annually, at the end of the year (retrospectively)
• FM+ can be claimed quarterly starting on April 1, 2024, and we recommend claiming it closer to the beginning of the quarter than the end (prospectively).
• FM+ quarters run April-June, July-September, October-December, and January-March. 

There are two basic principles for migrating from CCM to FM+:

• Start claiming FM+ age-based panel payments and indirect clinical services in April 2024.
• Use the chart below to determine when to submit your final CCM claims and when to begin your FM+ disease clusters. It’s important to remember that FM+ Disease Clusters should be initiated in the quarter after your final CCM claim. Manitoba Health will not accept CCM claims on a patient after an FM+ Disease Cluster claim has been processed.

CCM to FM+ Claims Migration

For FM+ disease cluster claims, however, it may be worth delaying your first claim. This is because Manitoba Health will not accept a CCM claim for a patient after an FM+ disease cluster has been claimed. With this rule in mind, our staff has carefully run the calculations to determine:

• When it’s better to submit your final CCM claim and delay starting to claim FM+ to the following quarter, or
• When it’s better to forgo your final CCM claim and start claiming FM+ in April 2024.

In all scenarios, physicians should start claiming FM+ age-based panel payments and indirect clinical time in April 2024.

The Simple Approach

The following table provides guidance for family physicians looking for a simple approach to determine when to submit their final CCM claim and when to begin claiming FM+ disease clusters.

The Meticulous Approach

For CCM claims in the Jul-Sep quarter, there are some patient scenarios for which it might be better to start FM+ earlier than in chart above. Your clinic can use EMR queries to identify patients’ diagnoses to help calculate the new FM+ quarterly payments and old annual CCM payments to determine the most advantageous trade off. 

Example 1 – Better to Forgo CCM and Claim FM+ Earlier
There are two scenarios in which it is generally better to forgo the final CCM payment and start claiming FM+ in the Apr-Jun quarter:

1. A patient with just one CCM disease diagnosis, or
2. A patient that with diagnoses covered under FM+ but not under CCM.

For example: A patient with COPD. If you claim CCM and delay starting FM+ until the Oct-Dec quarter, you will receive a combined annual total of $125.75 for CCM and FM+. If you forgo your CCM and claim four quarter of FM+ starting in the Apr-Jun quarter, you would receive $130.00.

Example 2 – Better to Claim CCM and Delay Claiming FM+
A patient with 2+ CCM disease diagnoses is generally better to claim under CCM and wait to start FM+ disease cluster claims until the Oct-Dec quarter. 

For example: a patient with diabetes and hypertension. If you claim CCM and delay starting FM+ until the Oct-Dec quarter, you will receive a combined annual total of $193.82 for CCM and FM+. If you forgo your CCM and claim four quarters of FM+ starting in the Apr-Jun quarter, you would receive $175.00.