Am I missing billings? Services Manitoba family physicians often do not bill

The fees

When it applies and when it does not

• Regional intermediate visit, 8529 (A-119 to A-120). "The visit shall be a minimum of ten (10) minutes of physician time or the patient is over 65 years of age."
• Extended clinic hours, 5530 and 5531 (A-125 to A-126). The premium applies to services that start in the hours in the fee table. The clinic must keep at least 8 regular office hours between 8:00 a.m. and 5:00 p.m. on weekdays, or be an approved Extended Primary Care clinic. The extended hours must be advertised to the public or to your own patients. The patient must have the option of an in-person visit. "The time the service commences must be entered on the claim." It does not apply to "a patient scheduled to be seen before the extended hours period". It does not apply to the pharmacist call tariff, 8005.
• Family Medicine Plus panel tariffs, 8181 to 8185 (A-123). They are "claimable once per three-month time period for a patient enrolled on the physician’s panel." You claim one of the five per enrolled patient, by age. Only physicians who provide ongoing, comprehensive primary care to enrolled patients may claim Family Medicine Plus. Manitoba Health must also have the clinic's details (A-122). See who can claim Family Medicine Plus.
• Family Medicine Plus chronic disease tariffs, 8186 to 8190 (A-123). You claim one of 8186 to 8189 by the number of chronic diseases in separate clusters. You may add 8190 for a disease in the mental health cluster. They are once per three-month period. You, an allied health member of your clinic or a covering physician must have provided a medical service to the patient in the preceding 24 months.
• No Family Medicine Plus with chronic disease management (A-124). Family Medicine Plus tariffs "may not be claimed in combination with Chronic Disease Management Tariffs: 8431, 8432, 8433, 8434, or 8435." Visits to an enrolled patient may still be claimed in addition.
• Indirect clinical services, 8191 (A-124). These are patient-specific services you provide when the patient is not present. Charting is one of them. You may claim 30 minutes per calendar week for each 250 patients on your panel. You may claim no more than 12 units a week. "A calendar week is defined as Sunday to Saturday." The manual's example: a panel of 1,300 gives 5 blocks of 30 minutes, or 10 units a week. You must have provided primary care to your panel in the week you claim.
• Newborn and infant enrolment, 8180 (A-123). It "may only be claimed once per patient (lifetime maximum), upon enrolment into the physician’s panel." The child is under age 2. You must have provided a medical service in the preceding 24 months. "Tariff 8180 may be claimed in addition to a visit."
• Cervical smear, 9795 (A-119 to A-120; fee on N-3). It "may be claimed in addition to tariff 8529, where appropriate." The same note sits under 8540.
• Pelvic exam, 8448 (A-119 to A-120). It "may be claimed in addition to 8529 where a pelvic examination is provided." The same note sits under 8540. Rule 17 (Rules-5) gives the full description.
• Extended visit, ~8640 (A-120; Rules-12). It is for "two or more distinct complaints or problems". "The visit shall be a minimum of twenty (20) minutes of physician time." It is a provisional tariff, which the manual marks with a tilde (~). Rule 56 says you must send a descriptive report with the claim. The report gives the length of time.
• Intermediate virtual visit, 8321 (A-121 to A-122; Rule 62, Rules-13). This is a visit by telephone or video. "The visit shall be a minimum of ten (10) minutes of physician time or the patient is over 65 years of age." You may claim one virtual visit per patient per day. By telephone, 8321 needs a continuing patient relationship. One example: you provided an insured service to the patient in the preceding 24 months. Rule 62 lists the other cases.
• Pharmacist call about a renewal, 8005 (B-10 to B-11). No claim on a day you provide other medical services to the patient. One per patient per day. "Claims must include the words “prescription renewal”." It "is not to be used as a routine practice or to authorize repeat prescriptions for which long-term repeats would more properly have been authorized at the time of writing the initial prescription."

Worked example

What is often not billed

A cervical smear taken during an 8529 or 8540 visit is its own claim: 9795, $25.15 (A-119 to A-120, fee on N-3). 9795 is for a smear taken for cancer screening.