Physician Billing Changes from the Alberta Government 2020

Earlier this year, the Alberta government released 14 Alberta Health Care Insurance Plan (AHCIP) bulletins. These bulletins announced significant changes to the Schedule of Medical Benefits and other support programs for physicians that will impact the compensation physicians receive. Almost immediately, the world was hit with the COVID-19 pandemic and the focus shifted. Then the government announced that some of the changes would be rescinded, alter some of the changes, and delay others. So where do this stand now?

In this post, we’ll detail the changes that have been made and which ones have been rescinded. You can also check out our table of AHCIP bulletins for an overview all changes announced to date. All changes announced are effective March 31, 2020 unless noted otherwise.

Alberta Health has taken the responsibility for administering the Medical Liability Reimbursement (MLR) Program from the AMA. In doing so, the province is changing the deductibles for CMPA insurance fees. The new deductibles are shown in the table below. Urban physicians will pay varying deductibles according to specialty, ranging from $1,000 to $4,000. Rural physicians of any specialty will pay a $1000 deductible. The government had previously announced limited reimbursements and much higher deductibles for certain specialties (+$40,000 for obstetrics!) , but these deductible amounts were changed with the release of bulletin MED 232 on July 6, 2020.

Eligible physicians will need to apply for reimbursement through the MLR program. All applications must be submitted by December 31 to receive reimbursement for the current year. Payment of CMPA fees and reimbursement may be annual or quarterly. For annually payment physicians in the early reimbursement program, CMPA will delay its withdrawal of fees until August 1. Reimbursements are made directly to the physician’s bank account.

Relevant bulletins related to this changes: MED 218, MED 227, MED 232.

The application form and email for submission can be found here: https://www.alberta.ca/medical-liablity-reimbursement-program.aspx

The government is ending funding to the AMA for the Continuing Medical Education Program. The AMA will need to end or self fund the $2,684 previously provided to physicians for costs incurred with regard to the maintenance and enhancement of knowledge, skills and competency. Relevant Bulletin MED 219.

Physicians will receive lower compensation for overhead when a service is provided in a registered publicly funded facility. These new codes will likely be of lower value. For example, code 03.03A ($25.09) will be replaced by new lower value code 03.03AZ ($18.50).

Effective March 31, 2020, physicians are to use the new “z-codes” for services provided in a publicly funded facility. However, “z-codes” will pay at the higher in-office rate for all physicians until implementation of the lower rates on October 1, 2020. There is an exception for rural physicians. Rural physicians will be able to use billing codes that have overhead included and they will be exempted from any future changes to the policy. Below is a table of new out-of-office HSCs and the corresponding in-office HSCs. Relevant bulletins: MED 215, MED 223, MED 227.

The government added a daily patient volume payment rules that applies to all visit services with a “V” category code that are provided in a physician office. Physicians are paid 100% of code values up to 50 patients per day, 50% of code values for the 51-65 patients seen, and no compensation for 65 or greater. The cap does not apply to rural areas. The cap does apply to non-rural areas, defined as: Edmonton, Sherwood Park, St. Albert, Devon, Stony Plain, Leduc, Fort McMurray, Grand Prairie, Airdrie, Red Deer, Calgary, Medicine Hat, and Lethbridge. The government updated this announcement to exclude Health Service Code 13.82A from the cap (Psoralen ultraviolet A treatment, ultraviolet B or narrow-band ultraviolet B treatment). Relevant bulletins: MED 214, MED 220.

The Good faith claim program ended on March 31,2020. Alberta health will no longer pay for claims submitted in good faith for patients without a valid Alberta Personal Health Number (PHN). The patient can be billed privately. However, if the patient subsequently provides an Alberta PHN within 90 days of the date of service, the private billing amount must be reimbursed to the patient and a claim submitted to Alberta Health. Relevant bulletin: MED 122.

The Alberta government has changed the time limit for practitioners to submit claims to the Alberta Health Care Insurance Plan (AHCIP) from 180 days to 90 days. This change applies to both new claims (90 days after the date on which the health service was provided or the patient was discharged from the hospital) and resubmitted claims (90 days after the date on the last Alberta Health Statement of Assessment on which the claim appeared). Relevant bulletin: GEN 123.

Family Physicians

The Alberta Government has made changes to the Schedule of Medical Benefits to de-insure Development of a Comprehensive Annual Care Plan and the driver’s medical examination for Patients 74.5 Years of Age or Older. Relevant bulletins: MED 210, MED 211.

Radiologists

Diagnostic Imaging (DI) services that are referred by a chiropractor, physiotherapist, or audiologist de-insured from Schedule of Medical Benefits. Health Service Codes X301, X303, X311, X315, X316, X317, X318, and X319 have been amended to provide the correct interpretation of the services submitted in accordance with the Schedule of Medical Benefits. Relevant bulletins: MED 212, MED 213.

Rural Physicians

Business Cost Program (BCP) payments will be made at the rate of one BCP base payment per eligible claim. BCP payments for subsequent calls and modifiers associated with claims will be discontinued.
All other program parameters will remain the same. These changes are to be effective March 31, 2021. Relevant bulletin: MED 216.

Medical Liability Reimbursement Program

The government had announced limited reimbursements for CMPA insurance fees. This would have resulted in very high deductibles for some specialties, some over $40,000. This announcement was amended with MED 232 released July 6, 2020. The maximum deductible is now $4000. Relevant bulletins: MED 218, MED 227, MED 232.

Complex Patient Modifiers

The government had announced increased time thresholds for complex modifier codes. This bulletin were rescinded March 17, 2020. Relevant bulletin: MED 209.

Changes to Rural Remote Northern Program

The government had announced changes to the Rural Remote Northern Program (RRNP), eliminating Flat Fee payments and reassessing the Variable Fee Premiums payment component. This bulletin was rescinded April 27, 2020. Relevant bulletin: MED 227.

And that’s the current list of changes! We expect more changes to be announced and we will continue to keep you updated. Check out our table of AHCIP bulletins for an overview all changes announced to date. The Alberta government has also detailed a summary and rationale for the changes which might be of interest. If you have any questions questions regarding these changes or the impact to your billing, please get in touch – we’re happy to chat.