The representatives for Health and social services and your federation agreed to make some changes to article 4 of the ‘’Lettre d’entente’’ #241 notably, to maintain (code 42189) in some private practices, ‘’laboratoires d’imagerie médicale (LIM)’’ and ‘’résidences privées pour aînés (RPA)’’. The maximum allowed time to participate at a webinar for article 11 has also been modified.

These changes come into effect retroactively from 2020/12/7.

Moreover, ‘’ lettres d’entente’’ # 239, 240, 241 and 242 are being extended to 2021/10/31.

Mesure de maintien (article 4 – Code 42189) Cabinet 108, LIM 108 et RPA

Article 4.4 has been modified to include practices. If you have been affected by less activity, you can claim maintenance measure (code 42189) if you practice in:

a private office which has an agreement to article 108 ‘’Loi sur les services de santé et les services sociaux’’ and
which is designated by MSSS (practice 108);
a ‘’LIM’’ which has a permit delivered by MSSS which has an agreement to article 108 ‘’Loi sur les services de santé
et les services sociaux’’ and which is designated by MSSS (LIM 108);
a ‘’RPA’’ and you are a microbiologist.

When practice 108 and LIM 108 will be designated, they’ll be added to the list of CMS 108 available with the link.

Articles 4.6 and 4.7 have been modified. In a practice 108 or a ‘’LIM 108’’, you are paid by your actual remuneration mode in the installation of your establishment which concluded an agreement on the targeted service. So, the mixed remuneration is allowed in private practices and ‘’LIM’’ aimed according to pooled position of service who are allowed by negotiating parties. The benefits of the care rendered do not allow payment of increased fees in emergency. It allows the right to refund your travelling expenses according to “Annexe 23”.

Fee-for-service
If you give services in a practice 108 or LIM 108, payment for visits is established according to the applicable pricing:

In hospital for cases associated with surgeries (activity area: general cares unit, enter the date of the day in the
hospitalization box and for visits, use the code for the patient hospitalized in your discipline);
In an outpatient clinic for cases associated with PDT (activity area: outpatient clinic and for visits, use the billing
codes of the outpatient clinics in your discipline).
For any other services, enter activity area Outpatient clinic.

Services are considered to be provided in an establishment.

If the service is provided within the framework of telemedicine the article 13, you must enter context element LE 241 – Service rendu auprès de la clientèle hospitalière dans le cadre de la COVID-19 (shortcut #TELA) and Télémédecine par téléphone (shortcut #TT) or Télémédecine par visioconsultation (shortcut #TV) and see the billing notice under this section if necessary.

Hourly rate or mixed remuneration

Use ’’Demande de paiement – Tarif horaire, honoraires forfaitaires et vacation (1215) ’’ or ’’Demande de paiement –
Rémunération mixte (3743) ’’ and enter :

The practice number 108 or LIM 108 in the ’’Établissement ’’ box;
Activity code :
65391 (84391 if anesthesiologist) – Service rendered in a private practice 108 (Cabinet 108),
65392 (84392 if anesthesiologist) – Remote services rendered in a private practice 108 (Cabinet 108),
65393 (84393 if anesthesiologist) – Services rendered in ‘’laboratoires d’imagerie médicale’’ (LIM108),
65394 (84394 if anesthesiologist) – Remote services rendered in ‘’laboratoires d’imagerie médicale’’ (LIM108).

The nature of service 291XXX is not allowed.

Laboratory services in establishment (SLE) – 1606

If you are a physician specializing in radiology and you perform activities included in the manual of laboratory services in an institution, you can:

Use ‘’Demande de paiement à l’assurance hospitalisation – Rémunération à l’acte (1606)’’;
Fill the usual fields;
Enter the LIM 108 number in the ‘’Établissement’’ fields.

If, for a day or a period, you take advantage of one of the maintenance measures, you cannot bill for laboratory services in an establishment. Thus, if necessary, these services should be billed over a shorter period, to ensure that a billing day for a maintenance measure is not included in a billing period for your laboratory activities. The interpretation of a service given in laboratory medicine must be invoiced on the date the interpretation was performed, unless otherwise specified
in the Agreement.

The disposition does not apply to medical specialists in anatomo-pathology.

RPA (for physicians specializing in microbiology only)

Billing instructions :

For the maintenance measure and your quota, you must :
o for the place of dispensation, enter the number of the establishment to which you are attached.
o indicate the same start time for the quota as for the maintenance measure;
For any other services not included in the quota fee, for example a visit, enter the locality code of the RPA and check the ‘’Domicile’’ box (section Info supplémentaire).

Webinar organized by the FMSQ (article 11.2 – Code 42195)

The maximum number of one hour per week to a webinar organized by the FMSQ in the COVID-19 Pandemic (code 42195) now applies from Monday to Sunday.
This change is effective retroactively to December 7, 2020.

RAMQ will be ready to apply this rule on June 19 2021. Until then, you can continue to bill these services, but you may see denials on you billing statement. RAMQ will reassess the services concerned. You have no action to take.