Remuneration terms for services rendered during the Covid 19 pandemic and the ongoing restart of medical activities

Introduction :

Mesures de maintien (Support measures) were created to help the average hourly wage reach $211. They are divided in three categories:

• Support for unusual types of facility
• Support following reassignment
• Support for units of a hospital or specialized medical centre (CMS) experiencing a significant drop in volume.

Billing :

Mesures (Measures)

Lieux de pratique inhabituels (Unusual type of facility) -> Code 42187

Réaffectation (Reassignment) -> Code 42188

Baisse significative du volume d’activité (Significant drop in volume) -> Code 42189

*The translated terms are used in the sections below.

• Must be for at least 60 continuous minutes, then each completed period of 15 minutes is billable;
• Unusual types of facility / Reassignment -> Max. 12 hours per day
• Significant drop in volume (Article 4) -> Max. 10 hours per day
• Only one measure can be billed for the same period
• Billed as one or several periods, on a single claim
• For each period, use the code followed by ‘’0’’, the starting time and the ending time -> code:0:starttime-endtime
• The fee will be determined by the RAMQ
• Services de laboratoire en établissement (SLE) -> Cannot be billed while a support measure is claimed (except in anatomical pathology)
• Annexe 38 -> Only one billing line for each time slot (0h-7h, 7h-17h, 17h-0h)
  • Context element to use depending on what was claimed during the period (apply only between 7h and 17h on weekdays except holydays)
    • No per diem or half-per diem from Annexe 38 claimed -> #NPER
    • Half-per diem from Annexe 38 claimed -> #DPER
    • Per diem from Annexe 38 claimed -> #PER
  • For example

  This is how a support measure in an unusual type of facility, for a 10-hour period starting at 22h on 2021-02-01 and ending at 8h on 2021-02-02, should be billed (Use the À l’acte type of claim) to be able to add billing lines with different dates of service on one single claim that will include both the measures and the supplements, as per the instructions of the RAMQ):

  • Facility: Physician’s place of work
  • Line 1: (Date 2021-02-01) 42187:0:2200-2400
  • Line 2: (Date 2021-02-01) 42190:120:2200-2400
  • Line 3: (Date 2021-02-02) 42187:0:0000-0700
  • Line 4: (Date 2021-02-02) 42190:420:0000-0700
  • Line 5: (Date 2021-02-02) 42187:0:0700-0800
  • Line 6: (Date 2021-02-02) 42190:60:0700-0800
• Annexe 40 -> Only one billing line for each time slot (0h-8h, 8h-16h, 16h-0h);
  • Context element to use depending on what was claimed during the period :
    • No activity code from Annexe 40 – Anywhere but the emergency room -> #0H
    • 1 hour of activities from Annexe 40 – Anywhere but the emergency room -> #1H
    • 2 hours of activities from Annexe 40 – Anywhere but the emergency room -> #2H
    • 3 hours of activities from Annexe 40 – Anywhere but the emergency room -> #3H
    • 4 hour of activities from Annexe 40 – Anywhere but the emergency room -> #4H
    • 5 hours of activities from Annexe 40 – Anywhere but the emergency room -> #5H
    • 6 hours of activities from Annexe 40 – Anywhere but the emergency room -> #6H
    • 7 hour of activities from Annexe 40 – Anywhere but the emergency room -> #7H
    • 8 hours of activities from Annexe 40 – Anywhere but the emergency room -> #8H
    AND
    
    
    • No code of activity TH 77113 from Annexe 40 – Emergency room ->#0SU
    • 1 hour of activities (code 77113) from Annexe 40 – Emergency room -> #1SU
    • 2 hour of activities (code 77113) from Annexe 40 – Emergency room -> #2SU
    • 3 hour of activities (code 77113) from Annexe 40 – Emergency room -> #3SU
    • 4 hour of activities (code 77113) from Annexe 40 – Emergency room -> #4SU
    • 5 hour of activities (code 77113) from Annexe 40 – Emergency room -> #5SU
    • 6 hour of activities (code 77113) from Annexe 40 – Emergency room -> #6SU
    • 7 hour of activities (code 77113) from Annexe 40 – Emergency room -> #7SU
    • 8 hour of activities (code 77113) from Annexe 40 – Emergency room -> #8SU
  • For example

  This is how a support measure following a reassignment, for a 12-hour period from 8h to 20h on 2021-02-01, during which no other activity code – not in the ER and 8 hours of activity TH 77113 – ER was claimed, should be billed:

  • Facility: Where the physician’s mix mode contract is valid
  • Line 1: 42188:0:0800-1600#0H#8SU
  • Line 2: 42188:0:1600-2000#0H#8SU

Supplement :

A 20% increase supplement is added from 20h to 8h.

Lieux de pratique inhabituels (Unusual type of facility) -> Code 42190;

Réaffectation (Reassignment) -> Code 42191;

Baisse significative du volume d’activité (Significant drop in volume) in a designated unit and for a designated specialty -> Code 42192

• Billing format -> Code:minutes:starttime-endtime

Apply to the physician who is either infected, placed in quarantine for the protection of others or pregnant but working in a high-risk environment. They must remain available.

Impossible to do Télémédecine (Telemedicine) or impossible to be reassigned -> must remain available and must prove that no service was rendered.

From Monday to Friday (except on holidays) between 7h and 12h and between 12h and 17h, a half-day fee of $372 can be claimed for each period of availability of at least 3,5 hours. No other remuneration from the Accord-Cadre can be claimed during that time.

Activities cancelled within 24 hours -> Send a request to the Comité paritaire (Joint committee) to get the compensation.

Billing :

Médecin infecté, apte à rendre des services et disponible (Physician infected, able and available to work) -> TH activity code 291363

Médecin en quarantaine pour la protection d’autrui et disponible (Physician placed in quarantine for the protection of others, available to work) -> TH activity code 291364

Médecin enceinte qui exerce dans un lieu à risque pour sa grossesse et demeure disponible (Physician in pregnancy working in a high-risk environment, available to work) -> TH activity code 291365

For each half-day, select the time slot (AM or PM) and enter 1h (max. 2h / day).

The facility cannot be an office or locality code (5XXXX or 6XXXX)

Introduction :

Medical services rendered remotely, either by phone or videoconsult, can be billed according to the terms of the agreements.

Both the physician and the patient must be in the province of Quebec during the services (except physicians in bordering zones).

The services can be rendered from a facility, an office or the physician’s residence.

Billing:

*The translated terms are used in the sections below.

Radiologist -> The usual billing terms regarding remote readings still apply.

Ambulatory care patients -> Billable using the Clinique externe (Outpatient clinic codes).

• Context elements :
  • LE 241 – Service rendu auprès de la clientèle hospitalière dans le cadre de la COVID-19 #TELA
  AND
  • Télémédecine par téléphone (Phone) #TT
  OR
  • Télémédecine par visioconsultation (Videoconsult) #TV
• Facility -> Physician’s usual place of work
• Sector of activity -> Outpatient clinic
• Enter the starting time and ending time of the services
• Services rendered as per LE 161-A -> No sector of activity must be entered
• Services rendered as per Annexe 41 -> Select sector of activity Centre de douleur chronique (Chronic pain centre)

For physicians using the mix mode who do telemedicine outside of a facility (ex.: at home), the mix mode billing codes cannot be claimed except if the physician is infected, placed in quarantine or pregnant. Otherwise, follow these billing instructions:

• Context elements :
  • LE 241 – Service rendu auprès de la clientèle hospitalière dans le cadre de la COVID-19 #TELA
  AND
  • Télémédecine par téléphone (phone) #TT
  OR
  • Télémédecine par visioconsultation (Videoconsult) #TV
• Facility 99121 (fictive)
• Sector of activity -> Outpatient clinic
• Type of place in reference -> Patient’s current location (Telemedicine)
• Place in reference -> Physician’s usual place of work, with sector outpatient clinic
• Enter the starting time and ending time of the services

Cabinet (Private office) patients:

• If the usual Frais de cabinet (Office fees) stop being charged to the physician:
  • Billable using the Clinique externe (Outpatient clinic) codes
  • Context elements :
    • LE 241 – Service rendu auprès de la clientèle hospitalière dans le cadre de la COVID-19 #TELA
    AND
    • Télémédecine par téléphone (phone)#TT
    OR
    • Télémédecine par visioconsultation (Videoconsult)#TV
  • Facility -> 99111 (fictive)
  • Sector of activity -> Outpatient clinic
  • Enter the starting time and ending time of the services
• If the usual Frais de cabinet (Office fees) continue being charged to the physician:
  • Billable using the regular codes at the office
  • Context elements:
    • LE 241 – Service rendu auprès de la clientèle du cabinet dans le cadre de la COVID-19 #TELC
    AND
    • Télémédecine par téléphone (Phone) #TT
    OR
    • Télémédecine par visioconsultation (Videoconsult)#TV
  • Facility : RAMQ number of the office
  • Enter the starting time and ending time of the services

Visite principale (Principal visit) or Consult:

• Exam not required -> Billable remotely
• Exam required -> Not billable remotely and the patient must be seen in person

Maximum amounts billable :

• Annexes 40 or 38 :
  • Maximum 195 $ per completed hour of telemedicine
  • Last hour -> Maximum 75 $ per 15 minutes completed
• Others:
  • Maximum 300 $ per completed hour of telemedicine
  • Last hour -> Maximum 75 $ per 15 minutes completed

Temps discontinu (Non-continuous time):

• Cumulative time (a note must be recorded to that effect) -> #DISC
• Enter the starting time and ending time of the services. The total length of the services must be equal to the sum of all the separate periods of time worked during the day.

Majorations (Increases):

• Emergency care services are excluded
• Annexe 19 -> If the facility where a service would normally be rendered is located in a remote area where the fee gets a higher increase (except unusual type of facility, reassignment or CMS) -> In ‘’Type of place in reference’’ select ‘’Patient’s current location (Telemedicine)” and enter the facility where the service would have normally been rendered.

Physicians using the mix remuneration mode:

• Use the RM form and enter:
  • Facility -> Where the mix contract is valid
  • Sector of activity 53 Activités par voie de télécommunication
• Billable codes -> See the measures and situations in the Lettre d’entente 241.
• If none of the above applies -> Use the regular codes from Annexe 38 or 40.

Introduction :

These visits can be billed by the physicians of each specialty and replace the regular visit codes. They can only be billed for patients suspected or confirmed to have COVID-19.

Billing:

Unité de soins cohortée (Cohort care unit), Non ambulatoire (Non-ambulatory) SNT or hospitalization:

• Visite principale -> Code 15923 (max 1 per patient, per physician of the same specialty, per week)
• Visite de suivi (35$) (55% if RMX) -> Code 15924 (max 1 per patient, per physician or physician of the same specialty, per day
• Context elements -> Use the context that applies according to the situation (see the situations)

Flu clinic, ambulatory SNT or outpatient clinic:

• Visite principale -> Code 15925 (max 1 per patient, per physician or physician of the same specialty, per week)
• Visite de suivi -> Code 15926 (max 1 per patient, per physician or physician of the same specialty, per day)
• Context elements -> Use the context that applies according to the situation (see the situations)

Introduction :

*The translated terms are used in the sections below.

Allows for a daily compensation of $200 for each missed day at the office (proof required), from Monday to Friday except on holidays.

Applies if one of the following is claimed:

• Fee for reassigned physician
• Fee for infected physician
• Fee for physician placed in quarantine for the protection of others
• Fee for physician in pregnancy.

The facility must be considered high-risk.

Billing :

A request must be sent to the Comité paritaire (Joint committee) within 90 days following the missed day(s) including the required documents (if infected and unable to work -> within 20 weeks).

Introduction:

*The translated terms are used in the sections below.

Meetings and medical workforce reassignments related to the pandemic:

• $211/h compensation for COVID-related meetings.
• Must be for at least 60 continuous minutes.
• Can take place on-site, by phone or by videoconference.
• Also applies to the time allocated to reassigning the medical workforce (max. 4 hours per week unless specified otherwise)
• Annexe 38 or Annexe 40 -> 50% increase supplement
• No other compensation allowed for these activities (except the per diem from Annexe 38 and the forfaitaire (package) from Annexe 40).

Billing:

Meetings related to the pandemic:

• Facility -> Where the meeting took place. If done remotely -> Where the meeting would normally take place (Cannot be an office of locality code 5XXXX or 6XXXX)
• TH activity code -> 250380 Réunion en lien avec la pandémie LE 241
• Mix mode Annexe 38 or 40 -> TH activity code 251380 Réunion en lien avec la pandémie LE 241 – Tarif 50 %
• For a physician using the mix mode who participates in a meeting outside of the facility, use 250389 Réunion effectuée à distance en lien avec la pandémie – Mode mixte 100 % LE 241 dans le champ Code d'activité.

Effectifs médicaux (Medical workforce) reassignments:

• Facility -> Where the meeting took place. If done remotely -> Where the meeting would normally take place.
• TH activity code -> 250370 Réunion en lien avec la pandémie LE 241
• Mix mode Annexe 38 or 40 -> TH activity code 251370 Réaffectation des effectifs médicaux LE 241 – Tarif 50 %
• For a physician using the mix mode who participates in a meeting outside of the facility, use code 250388 Réaffectation des effectifs médicaux effectuée à distance – Mode mixte 100 % LE 241 dans le champ Code d'activité.

Other administrative and teaching duties (XXX171 to XXX252):

• Can be performed via an authorized videoconference platform or by phone

Administrative duties:

• Facility -> Where the duties would normally take place
• Sector of activity -> 51 Activité via vidéoconférence ou conférence téléphonique
• Activity codes -> Billing instructions from the Protocole d’accord

Teaching duties via Web platform:

• Facility -> Where the duties would normally take place
• Sector of activity -> 52 Activité via plateforme web
• Activity codes -> Billing instructions from the Protocole d’accord

Suspended duties:

• Comité pour l’achat d’équipements médicaux spécialisés (Specialized medical equipment committee) (TH activity codes 250236 or 251236)
• Comité sur des projets cliniques immobiliers (Clinical property projects committee) (TH activity codes 250241 or 251241)
• Activities presented in articles 11.1.5 et 11.1.6 Part II: Autres activités d’enseignement et d’évaluation of the Protocole d’accord (TH activity codes 252253 or 253253 / 252254 or 253254)

Introduction :

May be attended live or within 7 days of the original broadcast. The platform must confirm the physician’s attendance (proof of attendance must be provided if requested).

Billing:

• Billing code -> 42195 per completed hour (140 $/h)
• Billing format -> Code:starttime-endtime
• Context elements:
  • Webinaire – Le médecin a assisté en direct #WDIR
  OR
  • Webinaire – Le médecin a assisté en différé #WDIF
• Max. 1 hour per week
• No other compensation allowed (except the per diem from Annexe 38 or the package from Annexe 40)
• Annexe 38 or Annexe 40 -> 50% increase supplement
• Majorations (Increases) -> Annexe 19 not applicable

• Specialties involved -> Internal medicine, anesthesiology, general surgery and obstetric-gynecology
• Facilities involved:
  • Hospitals designated or in the process of obtaining the designation, to overtake the medical treatment of patients suspected or confirmed to have COVID-19 (unless an Garde support (On-call support) already exists for that specialty)
  • Hospitals where a Garde locale already exists (unless there is more than one Garde locale and unless an Garde support (On-call support) already exists for that specialty)
• Liste de garde (On-call duty schedule) -> Applies if the schedule is sent to the Comité conjoint (Annexe 25), starts on March 16 and ends on December 31, 2020.
• Other specialties -> A request may be sent to the comité conjoint if there is a need to be addressed (Annexe 25).