Recent Manitoba Health Claims Unit reviews reinforce a simple principle: bill the tariff that matches the service provided, and ensure your medical documentation supports it. 

The starting point should always be: What service did I provide, and does my documentation demonstrate that service? The tariff should follow the service — not the other way around. 

The most important distinction: focused vs. comprehensive assessment 

One of the most common billing questions we hear is: When should I bill a routine or focused visit, and when does the encounter support a Complete History and Physical Examination? 

A physician may perform an excellent assessment that includes a detailed history, physical examination, diagnosis, and treatment plan. That does not automatically make the encounter a Complete History and Physical. 

For example, a patient presenting with a shoulder injury may receive: 

• a detailed history; 
• a focused musculoskeletal examination; 
• review of relevant imaging; 
• a diagnosis; and 
• a treatment plan. 

This may represent excellent clinical care, but the service remains focused on the presenting problem and the patient’s needs. 

Likewise, a patient presenting with a respiratory illness may receive a thorough history, examination and treatment plan without the encounter becoming a comprehensive history and physical. 

A thorough assessment does not automatically qualify as a Complete History and Physical Examination (8540). The distinction is based on the scope of the examination and the patient’s clinical needs, rather than simply on how detailed or comprehensive the assessment is. 

Family Practice Visit Tariffs 

For common family practice encounters, select the tariff that best reflects the scope of the service provided. 

Age premiums and additional components

Applicable age premiums are applied automatically. Additional components, such as a pelvic examination or Pap test, may be claimed only when the service was actually provided, and the tariff requirements are met. Refer to the current Manitoba Physician’s Manual for details. 

➡️ See this article about visit types for more information.

Documentation: The Source of Truth 

Documentation should be clinically appropriate and detailed enough to support the service billed. Depending on the encounter, clearly record the reason for the visit, relevant history and examination, assessment/​diagnosis, clinical decisions, investigations, treatment, referrals and follow-up. 

Remember: The length of the note does not determine the tariff. A concise note can support a higher-value service if it demonstrates the requirements; a long note does not justify one by itself. 

Claiming for Team-Based Care 

Other health-care providers may assist with care, but a physician’s claim must be supported by the physician’s personal involvement in seeing the patient. Make your own assessment, examination, clinical decision-making and management plan clear in the record. 

Time matters

When a tariff has a physician-time requirement, ensure the required time is met and supported by the record. Recording encounter times can be useful during a review.