On-Call Coverage of Basic A/Basic B or Like Facility
This article applies to all physicians who provide on-call coverage of the emergency and out-patient departments of:
- “Basic A” and “Basic B” hospitals
- Gillam Hospital, Lynn Lake Hospital, Leaf Rapids Health Centre and Snow Lake Health Centre; and
- the communities of Hodgson, Churchill or Norway House; and are under contract of the University of Manitoba, Ongomiizwin Health Services (OHS).
The Agreements that apply to these physicians’ compensation provide them with a daily stipend for all days on-call and the right to submit fee-for-service claims for certain services during their on-call period. An independent contractor or salaried physician cannot claim services during their normal contract hours. Fee-for-service physicians on-call and other physicians on-call outside of their standard contract hours may bill fee-for-service for the following services:
- All obstetrical, surgical* and anesthetic procedures and services to a patient identified as CTAS1 or CTAS11 provided in the hospital while on-call.
- All medical services (including claims for Special Calls and After Hours Premiums) the physician provides in the hospital during twelve consecutive hours each weekday. (Twelve consecutive hours is known as the Billing Window. A physician may determine their Billing Window in consultation with the RHA).
- All medical services (including claims for Special Calls and After Hours Premiums) are provided in the hospital anytime on Saturdays, Sundays and general holidays.
- Includes, but are not limited to services billing under
- Tariff 0250 — Wound repair, multiple
- Tariff 0256 — Foreign body subcutaneous tissue, removal, complicated
- Tariff 0310 — Foreign body, subcutaneous tissue, removal, simple
- Tariff 0251 — Wound repair, simple, any location
- Tariff 0852 — Fractures: Upper extremity, Phalanges, fingers or thumbs, closed reduction
- Tariff 0980 — Fracture: Lower extremity, Phalanges, closed reduction
Frequently Asked Questions
Suppose I am a fee-for-service practitioner and my weekday Billing Window is from 9:00 a.m. to 9:00 p.m.: if I agree to provide on-call coverage from 9:00 a.m. Friday until 9:00 a.m. Saturday, when am I able to bill fee-for-service?
You are eligible to submit fee-for-service claims for services provided from 9:00 a.m. Friday until 9:00 p.m. Friday, as well as from 12:00 a.m. to 9:00 a.m. on Saturday. You are not eligible to submit fee-for-service claims for services provided from 9:00 p.m. Friday to midnight Friday, except for obstetrical, anesthetic and eligible surgical services.
When/how do After Hours Premiums apply?
If the service is eligible on a fee-for-service basis during your Billing Window, during one of the after-hours periods, as set out on page B‑1 of the Physician’s Manual, After Hours Premiums will apply to any urgent or emergent service when that service and where all other requirements comply with the tariffs. After Hours Premiums
During my Billing Window, I am called back to the hospital to attend to a patient in the ER. While still at the hospital, another patient presents at the ER that requires my attention. Can I claim a Special Call?
Claim Tariff 8598 — A Special Call for the first patient, but do not claim A Special Call for subsequent patients you see after arriving at a location. Special Calls.
A nurse phones me during my Billing Window regarding a patient presenting to the ER. I can manage the situation by telephone. Can I claim Tariff 8000?
Generally, no. Tariff 8000, Communication with an Allied Health Professional, is claimable only for specific categories of patients as set out on page B‑6 of the Physician’s Manual.