How do Family Medicine Plus chronic disease tariffs work in Manitoba (8186 to 8190)?

Manitoba fees for 8186 to 8190

When it applies

• “Family Medicine Plus tariffs may only be claimed for enrolled patients on the claiming physician’s Home Clinic panel.” (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 8186 – 8190 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: 8186, 8187, 8188, or 8189 where applicable and additionally may claim tariff 8190 where applicable.” (A-123)
• 8187 to 8189 count diseases “in separate clusters within the Medical Cluster Group”. Two diseases in the same cluster count once. For example, hypertension and coronary artery disease are both in the cardiac cluster. (A-123; A-125)
• “The physician, an allied health member of their clinic, or another physician providing coverage to the physician must provide a medical service to the patient in the preceding twenty-four (24) months.” (A-123) The service can be at any time in the 24 months before. The manual does not ask for a visit in the same three-month period. The ongoing care conditions below still apply.
• You or your team must provide care in line with the Manitoba Primary Care Quality Indicators Guide. You or your team must also keep coordinating with the patient's other providers. You or your team must also keep in touch with the patient and keep monitoring the patient's condition and care plan. (A-123 to A-124)
• Where needed, you or your team also screen and monitor the condition with validated tools, make brief interventions, write and review care plans, and make referrals. (A-124)
• You must provide care based on current standards and keep up your competency to manage these patients. Or you must work in a team that builds shared care plans. (A-124)
• The services must be documented in your EMR and sent to Manitoba Health. There are two ways. Your EMR sends a file to Manitoba Health each month. The manual calls this an EMR extract. Or the clinic sends an encrypted device each quarter, within 15 calendar days of the end of the quarter. The manual gives a CD or flash drive as examples of such a device. (A-124)
• “Claims for additional services rendered to a patient on the physician’s enrolled panel (e.g., visits) may be made in addition.” (A-124)
• The manual links to a list of the diagnosis codes (ICD codes) that apply to each disease. Check the patient's code against that list before you claim. (A-123)

The clusters

When it does not apply

• For a patient who is not enrolled on your Home Clinic panel. (A-122)
• When no medical service was provided to the patient in the preceding 24 months. (A-123)
• “Family Medicine Plus tariffs may not be claimed in combination with Chronic Disease Management Tariffs: 8431, 8432, 8433, 8434, or 8435.” (A-124)

Worked example

What is often not billed

8190 is its own claim. It is claimed in addition to 8186 to 8189, not instead of them (A-123). The chart must show a disease in the Mental Health Cluster, such as depression or anxiety (A-125). A medical service in the preceding 24 months is still required (A-123).