Generally, whenever a physician is requested to assess/treat a patient on an unscheduled/unplanned basis i.e., the service is not part of the physician’s regular routine and the physician must travel from one location to another to attend the patient (e.g., from the physician’s home to the hospital or office, from the office to a personal care home, from one hospital to another hospital that is not in the same building complex, etc.) a Special Call may be applicable.
The Physician’s Manual defines a Special Call under Rule of Application #3 and on page B‑3 as follows:
SPECIAL CALL Whenever a physician is required to make a special trip, over and above the physician’s regular routine, to attend a patient, a Special Call benefit may be claimed in addition to the benefits listed for assessment and/or procedural medical services (except as listed below). Only one (1) Special Call per response is applicable. A Special Call must be initiated by someone other than the physician (except when services are rendered outside the hospital) and requires the physician to travel from one location to another (not within the same building complex) to attend the patient. A Special Call benefit will be paid even if the patient is deceased, on the arrival of the physician called, or, if the patient has left the premises prior to the physician’s arrival provided the physician was not unreasonably tardy. Subject to the Exclusions listed below, all Special Call benefits may be claimed under the following tariffs:
|8561||For special calls made to a patient’s home|
|8598||For special calls made to the emergency department or O.P.D. of a hospital|
|8566||For special calls in obstetrics|
|8567||For special calls made in non-elective surgical cases, in the postoperative period|
|8563||All other special calls not covered under Tariffs 8561, 8566, 8567 or 8598 (including, but not limited to, special calls made to personal care homes and to attend to registered hospital patients, subject to Exclusion (a) below) may be claimed under this tariff|
Special Call benefits do not apply under the following circumstances:
- Care to registered hospital patients during the physician’s regular daily round.
- Regularly scheduled daily office appointments.
- Scheduled N.F.A. medical services.
- Routine care provided to patients in personal care homes.
- Scheduled routine in-patient surgical activity.
- Where the physician is already in the hospital.
- All elective surgery both pre and postoperative.
- In obstetrical care, on the day of delivery, by the physician performing the delivery or the elective caesarean section.
A special call may not be claimed:
- when a resident or other professional attends the patient on your behalf
- for telephone or other communications services, e.g., Tariffs 8000, 8001, 8003, etc.
- for second or subsequent patients you assess after you have arrived at a location
- by specialists who are providing “in house” coverage
- by anesthetists who are providing out of hospital coverage to Winnipeg Tertiary and Community Hospitals
- when the “trip” was part of your regular routine, i.e., daily hospital rounds, weekly PCH rounds, scheduled services in your office or at the hospital.
- for elective caesarian sections.
Provided the other elements of the special call are met, a spcial call shall be paid in the following circumstances:
- When diagnostic interpretations are provided on an unscheduled urgent/emergent basis, notwithstanding that the physician does not assess the patient directly, e.g., request for an interpretation of EEG or Radiology film, claim Tariff 8563 and include remarks that the service was urgent/emergent.
- For emergency surgery, where the surgery is unscheduled and the surgeon is requested to return to the hospital once an operating suite is available; claim Tariff 8563, but remember, the surgeon may also be entitled to be paid a special call with respect to the initial assessment of the patient.
- For special calls in the post-operative period following emergency surgery notwithstanding that post-operative care may not be payable, claim Tariff 8567
- For visits to personal care homes when the trip was not a part of regular rounds, claim Tariff 8563.
- For visits to a patient’s home, claim Tariff 8561.
- In obstetrical cases, as long as the time of delivery is 12:01 a.m. or later, the day after the physician originally assessed the patient, claim Tariff 8566 with respect to the attendance for initial assessment.
- In obstetrical cases where the physician performs the emergency caesarian section, claim Tariff 8566.
- In obstetrical cases where the physician attends to assess the patient but does not perform the delivery, claim Tariff 8566
- For special trips to your office to assess a patient on an unscheduled basis, claim Tariff 8563.
After Hours Premiums
Where the special call is rendered in conjunction with an urgent/emergent service in an after hours time period, After Hours Premiums apply to the special call fee, in addition to the fees for the other services provided.
Multiple Special Calls Same Day
Where the physician has been called back to a location, departed and thereafter requested to return to the same location another special call may be claimed. For audit purposes, it is recommended that you note in the chart the person making the request and time you returned for each subsequent special call claimed on that day. Where the second or subsequent special call is for the same patient, a remark specifying the time of each of the special call services should be included with your claim.