Alternate-funded MDs: Can you ever bill fee-for-service?
Under many alternate funded contracts, full-time physicians will be paid to provide a set number of hours of medical services per week.
As frequently happens, however, physicians work more than the set hours per week. The question becomes: How are physicians who are subject to an alt-funded contract paid when they provide medical services in excess of the hours stated in their contract?
As a general rule, where a physician is providing medical services in excess of the stated hours (and is NOT on-call at a Basic A or B emergency room or a personal care home) the physician will be compensated at the regular hourly rate stated in their contract. A few examples of when this applies are as follows:
- As a result of providing medically necessary services, the physician is required to remain at the clinic/hospital beyond their normal office hours.
- The physician is called by a nurse or allied health care worker with regard to one of their own patients and the physician determines it is necessary to attend to the hospital/personal care home to examine that patient.
- The physician is part of an on-call rota approved by the RHA and is called by a nurse or allied health care worker and the physician determines it is necessary to attend to the hospital/personal care home to examine that patient. (Note: this does not apply where the physician is providing on-call services pursuant to the Personal Care Home On-Call Agreement).
- The physician agrees to conduct an evening or weekend clinic.
- The physician attends the hospital on a weekend or designated holiday and conducts rounds.
Where can alternate-funded physicians bill fee-for-service?
As a general rule an alternate-funded physician may not claim fee-for-service for regular service provided beyond their set hours except as outlined below.
There are several circumstances where a physician is entitled to bill fee-for-service when providing services outside of their normal office hours. These include:
- Where a physician provides unscheduled obstetrical services;
- Where a physician is providing on-call services pursuant to the Personal Care Home On-Call Agreement (see Personal Care Home After-Hours On-Call Coverage); and
- Where a physician is providing on-call services pursuant to the Basic A & B ER Agreement.
In the case of Basic A & B ER coverage, when the physician is receiving the on-call per diem the following rules apply:
- During the physician’s normal office hours of work the physician shall receive their regular hourly rate and may not bill fee-for-service.
- In accordance with the Basic A & B ER Agreement the physician may bill fee-for-service during the physician’s billing window (12 hours on weekdays and 24 hours on Saturday, Sunday and general holidays) for hours that fall outside of normal office hours.
- Where the physician completes rounds on a Saturday, Sunday or general holiday and has provided 40 hours of medical services that week, the physician shall be paid their hourly rate in addition to the daily stipend.
It is important to remember that a physician may not, at any time, bill fee-for-service while at the same time receiving the hourly rate under his/her contract and/or counting those hours towards their contractual obligation.
Note: Alternate-funded physicians may not, under any circumstances, bill Tariff 8520 Hospital Care.