Remuneration terms for services performed in the context of the pandemic caused by COVID 19 – GENERAL PRACTITIONERS

Here is the relevant information regarding the new terms, adjustments to existing terms and billing details for services related to the current pandemic:

The Lettre d’entente 269 is valid from February 28, 2020, except for services performed remotely (teleconsultations) which are valid from March 16, 2020. Please note that the billing deadline has been temporarily extended to 120 days.

Six COVID-19 situations (more than one situation may affect remuneration) >

Choose 1 or 2 depending on the usual mode
Choice 1 – USUAL REMUNERATION MODE – FEE-FOR-SERVICE OR MIXED:
Conditions:
  • Physician performing services remotely, from any place/sector/location
  • No contract/designation required
Application rules:
  • Apply #DC19 Service rendu à distance dans le cadre de la COVID-19 on each service and supplement:
Visits (office / GMF-U / CLSC)
  • First-time visit / Orphan patient package / Annually GMF package 8875 -> Billable. Examination required = Plan to a future appointment.
  • Periodics -> Not billable if an exam. is required. Choose follow-up or Clinical intervention (IC) if it is the case.
  • Follow-up visit/Walk-in visit/Clinical intervention
    (IC) -> Billable.
  • Severe loss of autonomy visit -> Not billable. Select another type of visit.
  • Can be billed as usual
  • No limitation
  • Not restricted to the number of registered patients
    (- 500 patients -> use 15841 or 15844)
  • Patient diseabled/immature -> Bill the service as if with the patient
  • Less than 25 minutes -> Use code 15909
  • 25 minutes and over -> Bill a clinical intervention (IC)
  • VSE (codes 15617, 15628, 8913 or 8942) -> Billable if equiv. to complex walk-in visit
  • VSC (codes 15616, 15627 or 8933) -> Billable if equiv. to minor walk-in visit
  • Ordinary exam. / Ord. consult. -> Billable if equiv. to minor walk-in visit
  • Main exam. / Major consult. -> Billable if equiv. to complex walk-in visit
  • Physician on-duty on follow-ups for patients previously seen at the ER -> Bill as if he/she was on site
Choice 2 – USUAL REMUNERATION MODE - HOURLY RATE OR FIXED FEE:
Conditions:
  • Physician performing services remotely, from any sector/facility
  • Usual remuneration contract
Application rules:
  • Apply context element #DC19 Service rendu à distance dans le cadre de la COVID-19 for all the supplements (patients)
  • Use hourly rate code -> XXX319 Services cliniques à distance (pandémie COVID-19)
Daily Choices
Choice 1

HOURLY RATE:

Conditions:
  • Physician on the “hot zone” on-duty schedule
  • LE 269 designated facility/unit
  • Billable during operation hours of the CDÉ/Unit
Application rules:
  • Code 19680 ($186.15/hour) -> Fixed rate per hour package ( )
    • Service: between 8 a.m. and noon 0XXX7 designated facility:
    • Sector: Clinique d’urgence
    • Start time: 08:00
    • Billing code: 19680:240
  • Code 19683 ($35.30/hour) -> Unfavourable hours package (6 p.m. to midnight Mon-Fri (except holiday) / all day weekend and holidays) ()
    • Service ON SATURDAY between midnight and 8 a.m. 0XXX7 designated facility :
    • Sector: Clinique d’urgence
    • Start time: 00:00
    • Billing codes: 19680:480 + 19683:480:0000-0800
  • Code 19681 ($62.75/hour) -> Office fees/expenses package (Physician assuming office expenses for his usual clinic) ( )
    • Service between noon and 4 p.m.,ON A HOLIDAY, when the physician would normally work at the office:
    • Sector/facility: Choose designated facility/sector where he/she is
    • Start time: 12:00
    • Billing codes: 19680:240 + 19683:240:1200-1600 + 19681:240
  • SERVICES -> No other remuneration
Questions/Answers:
For the evaluation clinics (CDÉ), GMF and GMF-R, physicians having a on-duty schedule for a portion of the day could bill the rest of the day using the usual remuneration mode. If the duty exceeds the CDÉ opening hours, the usual mode must be billed outside operations hours.
No
A physician who is part of the “hot-zone” on-duty schedule and who must cover all zones must choose between the fixed fee package and his/her usual mode.
He/she should bill using the usual remuneration mode.

  • For any other question, check the FMOQ’s Q/A tools
Choice 2

MAINTAINING THE FEE-FOR-SERVICE OR MIXED REMUNERATION MODE:

Conditions:
  • Fee-for-service or mixed remuneration usual mode
  • Not billable if choice 1 fixed rate per hour package (code 19680) is billed
  • Physician on the “hot zone” on-duty schedule list
  • LE 269 designated facility/Unit
Application rules:
  • Services/package fees -> Bill the package fees/services as usual with context element #C19
  • Compensation for office expenses (outpatient clin., CLSC or GMF-U) -> One of these supplements that can be billed in addition to the visit:
Eligible examinationBilling codeRate ($)
Ordinary exam, or walk-in minor visit, all ages (billing code 5, 8882, 8883, 15765, 15766, 15767, 15768, 15769, 15770, 15771, or 15772) 153007,65
Complete exam for a patient less than 70 years old or walk-in complex visit for a patient less than 80 years old (billing code 56, 15773, 15774, 15775, or 15776)1530113,35
Complete exam for a patient 70 years old or over, or walk-in complex visit for a patient 80 years old or over (billing code 9116, 15777, 15778, 15779, or 15780)15302 21,45

MAINTAINING THE HOURLY RATE OR FIXED FEE MODE:

Conditions:
  • Usual hourly rate or fixed fee contract
  • Not billable if choice 1 fixed rate per hour package (code 19680) is billed
  • Physician on the “hot zone” on-duty schedule
  • LE 269 designated facility/unit
Application rules:
  • Use hourly rate code XXX346 Services cliniques – COVID-19. (Remplace code TH XXX158 Services clinique de grippe)
  • Invoices signed by authorized professional (signataire)
  • Consultation register -> No
PREVENTIVE WITHDRAWAL
Conditions:
  • Pregnant physician who accepts to be reassigned
  • If she cannot be reassigned, she must remain available
Steps for the request:
  • Get a signed notice of preventive leave of absence by a physician
  • Submit the notice to the DSP or DRMG
  • Get the authorization from the joint committee (comité paritaire)
Terms:
Reassigned physician on hourly rate mode:
  • (Medical duties) -> Use hourly rate code XXX344 Tâches médicales – Retrait préventif
  • (Medico-admin. duties) -> Use hourly rate code XXX345 Tâches médico-administratives – Retrait préventif
Reassigned physician on fee-for-service mode:
  • Bill the services with context element #DC19 or #C19 as appropriate
Non-reassigned physician:
  • Isolation measures
ISOLATION MEASURES / SICK LEAVE
Conditions:
  • As of March 1, 2020
  • Must not be working
  • Eligible if infected with COVID-19
  • Eligible if exposure can be demonstrated to joint committee (if not in a COVID clinic)
  • Eligible if in recommended isolation measures
Steps for the request:
  • Summary of contamination activities and activity locations
  • Consent to a remuneration analysis
Terms:
  • Reference -> Based on the last 12 months (or according to the months worked)
  • Compensation -> 100 % of gross income
  • Duration -> Depending on the number of days off, not exceeding 90 days
  • Delay to send the request -> In the 20 weeks following the leave
PATIENTS SEEN OUT OF THE ICU (EXCEPT LE 269 DESIGNATED UNIT)
Conditions:
  • On-duty physicians in an ICU
  • IC beds outside the ICU
Application rules:
  • ICU sector and choose global package fee EP 3 (9997 or 8896) OR ward fee-for-service
  • If intubation procedure -> code 182
PATIENTS SEEN OUTSIDE THE ICU – IN AN LE 269 DESIGNATED UNIT
Conditions:
  • LE 269 designated ICU LE 269
  • ICU beds in a “hot-zone” unit
Application rules:
  • Daily choice between the fixed rate per hour package (see Situation 2, Choice 1) or global package fee EP 3 or ward fee-for-service
  • Fee-for-service/EP3 choice -> Apply context element #C19 on all services
CLSC AT-HOME INTENSIVE CARE
Conditions:
  • Be part of a SIAD LE 336 team
  • Medical services for patients in the CLSC SIAD program
Application rules:
  • Codes 42148 and 42151can be billed even if not all conditions are met
  • Apply context element #DC19 or #C19 as appropriate
DUTY FOR INTUBATION OF COVID-19 INFECTED PATIENTS – LE 352
Conditions:
  • LE 269 designated facility/unit
  • No service rendered in another sector during the targeted period
  • 1 package per 24 hour per facility
Application rules:
  • IC (clinical intervention) -> Not calculated in the 180 minutes daily maximum if the context element #IC19 Intervention clinique effectuée pour l’intubation d’un patient COVID positif durant sa garde is applied.
ON-CALL DUTY
Conditions:
  • LE 269 designated facility/unit LE 269
  • In an Intermediate resource, Senior’s residence, or GMF
  • The DRMG head must forward the list of nominated physicians
  • No service contract (nomination authorizes billing)
  • Must be part of EP38 designated facility
Application rules:
  • Type of package fee (Use regular, reduced or bonified (codes) as determined by the facility (EP38 )
HEAD OF DEPARTMENT OR IN CHARGE PHYSICIAN
Conditions:
  • Coordination linked TO COVID-19
  • Can be performed remotely
  • Physician must be designated as per code agreement
  • Contract may be required as per code
  • The bank of hours will be adjusted
Application rules:
  • 2 package per hour, Apply #DC19 and bill at concerned service dates
    • DRMG head (code 19906)
    • Coord. physician (code 19103)
    • General medicine clinical department head (code 19064)
    • CHSGS ER department head or his/her assistant (code 19040)
  • Protocol of agreement -> Use hourly rate code 103324
  • GMF/GMF-R head -> Use hourly rate code 72101with SECTOR 47
  • Designated CDÉ/SNT/Unit LE 269 leader -> CISSS/CIUSSS instit. number and use hourly rate code 103324
  • Unmerged CHSLD -> Bill EIT (code 15621 ) with context element #DC19
OTHER PHYSICIANS
Conditions:
  • Coordination linked to COVID-19
  • Can be performed remotely
Application rules:
  • 2 package per hour apply context element #DC19 and bill at concerned service dates:
    • CHSGS ER department (codes 19883 to 19888)
  • GMF -> context
    • Use hourly rate code 72101 while respecting the allowed bank of hours
    • If hourly rate code 72101, allowance is exceeded, check with DRMG to be remunerate

NEW CONTEXT ELEMENTS >

Élement de ContextDescription
DC19LE269 – Service rendu à distance dans le cadre de la COVID-19
C19LE269 – Service rendu en présence du patient dans le cadre de la COVID-19
IC19LE269 - Intervention clinique effectuée pour l’intubation d’un patient COVID positif durant sa garde

OTHER MEASURES >

Quarterly cap (Plafond trimestriel)
  • Quarterly cap -> Remuneration for services performed in a clinic dedicated to COVID-19 is excluded from the gross quarterly income calculation for the determined period.
Attendance rate (Taux d’assiduité)
  • Attendance rate -> A patient visit performed in the context of the Lettre d’entente 269 is excluded from the attendance rate calculation.