Hospital Care — Tariff 8520
Rule of Application 12 governs the claiming of hospital care tariffs:
“Hospital Care applies to the care of registered bed patients formally admitted to the hospital, benefits for which are listed on the Visit Pages, and are claimable from the date of admission to the date of medical discharge by the attending physician. Only one visit per day, per patient, will be paid for in-hospital care regardless of the necessity of multiple visits on the same day. Whenever a visit to an in-patient necessitates a special trip, however, as defined in Rule 3, a Special Call benefit will also apply. According to the Rules of Application governing chronic care, visits will be claimable on a per-visit basis after the date of medical discharge.”
Accordingly, the attending physician may claim the hospital care per diem Tariff 8520 Hospital care — per day for each day of the patient’s hospitalization from admission to the date of discharge.
Subject to the substitution noted below, attending physicians will receive payment for Tariff 8520 for each day of hospitalization regardless of whether they “saw” the patient on any particular day. During hospitalization, if the patient develops a new problem or their condition deteriorates, the attending physician may need to perform a complete examination or re-examination of the patient.
In these situations, it is permissible to claim a different hospital visit tariff, e.g., Tariff 8540 Complete History and Examination, in lieu of Tariff 8520 for that day. The attending physician resumes claiming Tariff 8520 on the following day and thereafter. For units with rotational coverage of in-patient care, a complete examination may not be substituted for Tariff 8520 solely due to the attending physician’s routine changeover, except as noted below.
Billing Notes — Tariff 8520
- Tariff 8520 may be claimed in addition to the applicable tariff for a complete/regional visit or consultation service on the same day when the visit or consultation was provided in the Emergency Room or Outpatient Department before the hospital admission.
- In Manitoba Health-recognized clinical teaching units (CTUs) only, a complete examination or complete re-examination may be claimed in lieu of Tariff 8520 for all patients upon the attending physician’s changeover. Manitoba Health recognizes the following:
- Medical CTUs HSC (3 units: A4, D4, H4), SBH (2 Units: A & B)
- Pediatric CTUs: Children’s Hospital (Oak, Elm, Pine)
- Cardiology CTU SBH
- Grace Hospital CTUs
- Also, a CTU attending physician may claim Tariff 8526. See below for further information regarding Tariff 8526.
- When a visit to an in-patient necessitates a special trip, a Special Call (e.g., Tariff 8563 or Tariff 8567) may be claimed, even if a visit or examination fee is not billable. If the special trip was provided after hours on an urgent or emergent basis, after-hours premiums are also applicable to the special call.
- After-hours premiums may not be claimed in conjunction with Tariff 8520.
- Tariff 8520 may not be claimed during the inclusive post-operative care period for a patient following a major surgical treatment. Alternately-funded physicians who provide emergency coverage to Basic A or B ER/OPD facilities are not entitled to claim tariff 8520 unless specifically permitted to do so in their contract.
Tariff 8526 — CTU Patient Care Supplement — per day
- May be claimed by the CTU attending physician for each patient admitted to a CTU recognized by Manitoba Health.
- Tariff 8520 and/or other applicable visit/examination services are payable also.
Tariff 8526 is to be billed once per patient per day by the CTU attending physician in addition to Tariff 8520.