Manitoba Health is more closely scrutinizing and reviewing some fee-for-service claims. With more claims being held for review, now is a good time to brush up on billing requirements and make sure your claims align with the Physician Manual.

What we’re seeing: Manitoba Health is paying closer attention to claims in several areas, including complete history and physical examinations by Family Physicians/​General Practitioners, virtual comprehensive visits and after-hours premiums.

• Completes are trending up: Our review of billing trends found completes accounted for about 30% of all visits last year, up from about 18% before the pandemic. 

🔍 Brush up on billing: We’ve updated our resources to help you choose the right tariffs and ensure your claims align with the requirements and intent of the Physician Manual.

• Review our updated articles on complete exams by family physicians & GPs as well as virtual visits and after-hours premiums (including how they differ from extended hours premiums).
• Check our overview of common FP/GP visit types to ensure you select the right one, including the new extended visit for patients with two or more issues.

Remember: Even if a third-party billing firm or clinic owner handles your billing, you are ultimately responsible for claims submitted on your behalf. If claims are held or audited, your financial well-being is at stake.

• Read our new Billing Accountability and Accuracy resource.

👀 What concerns us: This summer, we’ve seen examples where all payments to some physicians have been frozen while claims are held for review, possibly because billing practices appear to be outliers. While Manitoba Health has long been able to review individual claims, we are concerned there is no clear process to resolve these broader payment holds.

• We have raised these concerns with senior Manitoba Health officials and are pushing for clarity and fairness in all claim reviews.
• If your claims are held: We’ve created a new resource explaining what to expect, how to respond to Manitoba Health and when to contact Doctors Manitoba for help.

Bottom line: The Physician Manual is complicated, with thousands of tariffs and unique rules and requirements. Our billing resources can help you claim the right tariffs for the care you provide. And if your claims come under review or you are audited, we’re here to help.

Contact us or book a confidential billing review by emailing us at practiceadvice@​doctorsmanitoba.​ca.