How do Family Medicine Plus age-based panel payments work in Manitoba (8181 to 8185)?

Manitoba fees for 8181 to 8185

When it applies

• “Family Medicine Plus tariffs may only be claimed for enrolled patients on the claiming physician’s Home Clinic panel.” (A-122)
• “‘Enrolled patient’ means a patient whom the family physician has reached an understanding to be the patient’s most responsible provider and is responsible for their ongoing primary care.” (A-122)
• The enrolment must be recorded in your EMR and sent securely to Manitoba Health, in a form Manitoba Health's system can read. There are two ways to send it: the Home Clinic Portal, which is an enrolment website, or a file your EMR sends securely to Manitoba Health each month. The manual calls that file a data extract. (A-122)
• You must provide ongoing, comprehensive primary care to your enrolled patients. You must also have given Manitoba Health the clinic's address and contact information, and the number and type of practitioners who work there. (A-122)
• “Tariffs 8181 – 8185 are claimable once per three-month time period for a patient enrolled on the physician’s panel.” The periods are April 1 to June 30, July 1 to September 30, October 1 to December 31 and January 1 to March 31. (A-123)
• “A physician may claim one of the following tariffs: 8181, 8182, 8183, 8184, or 8185 per enrolled patient.” (A-123)
• “Claims for additional services rendered to a patient on the physician’s enrolled panel (e.g., visits) may be made in addition.” (A-124)

When it does not apply

• For a patient who is not enrolled on your Home Clinic panel. (A-122)
• “Family Medicine Plus tariffs may not be claimed in combination with Chronic Disease Management Tariffs: 8431, 8432, 8433, 8434, or 8435.” (A-124) These are the annual chronic disease management tariffs, such as 8431 for diabetes (A-130). They are not the Family Medicine Plus chronic disease tariffs, 8186 to 8190.
• Not settled by the manual: pages A-122 to A-124 do not say which date sets the patient's age for a three-month period. If a birthday moves a patient into a new age group during a period, ask Manitoba Health which tariff applies.

Worked example

What is often not billed

The notes for 8181 to 8185 name one condition for the patient: the patient is enrolled on your panel (A-123). They do not name a visit in the period. So the claim is easy to miss for an enrolled patient you did not see in that three-month period. The enrolment must be recorded in your EMR and sent to Manitoba Health (A-122).