Even though the Letter of Agreement 241 expired on May 14, 2022, the terms and conditions related to telemedicine remain. Therefore, we feel it is important to provide you with a few reminders:
Introduction: in order to be eligible for payment, you must spend a minimum of 15 minutes per day on telemedicine. The RAMQ applies a daily cap of $300 per cumulative hour of telemedicine for physicians paid on a fee-for-service basis (i.e. $75 per 15 minutes completed) and $195 per cumulative hour for physicians paid on a mixed basis (i.e. $48.75 per 15 minutes completed). The total time is rounded down to the nearest 15 minutes (for example: for 50 minutes of telemedicine, the ceiling is counted as 45 minutes). The physician whose billing exceeds this maximum will have the excess amount cut off on a future statement. For the billing already transmitted, the RAMQ adjustments have already begun. Do not be surprised if you see retroactive recoveries on your statements…
Practical application: All the services rendered in telemedicine during a day as well as the duration that you have indicated in your billing (therefore in your notes) determines if the ceiling is reached. In fact, all the minutes of the acts done in telemedicine during the day must be added up in proportion to the 15 minutes completed. For example, if the total minutes add up to 50 minutes, only 45 minutes count towards the cap. If the total amount exceeds $48.75 for each 15 minutes completed on a blended basis and ($75 for each 15 minutes completed on a fee-for-service basis), then RAMQ will adjust your payment downward.
Example in internal medicine for outpatients :
3 patients in telephone follow-up:
Patient 1: main visit from 10:30 to 10:45 am = service worth $54.75 (15 minutes)
Patient 2: main visit from 11:00 to 11:08 = $54.75 (8 minutes)
Patient 3: main visit from 11:30 to 11:37 = $54.75 (7 minutes)
Total services = $164.25. Total hours in telemedicine = 30 minutes Cap of $300 per cumulative hour for a fee-for-service physician. For 30 minutes the cap is therefore $150. You have overbilled and will be cut off on your next statement ($164.25 – $150 = $14.25).
The start time is always the actual start time and the end time is determined by the total duration of your file. You must include the preparation of the file (even if it is discontinued), as well as the visit and the required note. In the case of discontinued services, you must add the following context of element in addition to the telemedicine context of element: Time of discontinued service in telemedicine (shortcut #DISC). The end time will be calculated according to the duration of your telemedicine. It is important to always include the discontinuous time for each visit (when applicable) in the notes for each of your records. The notes must reflect this reality. Example: Visit from 10:00 to 10:15 + chart notes from 11:00 to 11:15. The start time will be 10:00 am and the end time will be 10:30 am (with telemedicine context element and the discontinued service context element).
We hope that you will be able to find out more about these arrangements. If you have any questions, please do not hesitate to contact us.
Your Medical Billing Team