Out of Office Hours Premiums and Emergency Visits Information

Out-of-Office Hours Premiums and
Emergency Visits Introduction

The examples used in the Emergency Visits and Out-of-Office Hours Premiums modules of MSP Tutor have been simplified for clarity, and use visit fees from the Section of General Practice. Appropriate specialist visit fees or consultation fees should be used when submitting claims for services by a referred specialist.

General Billing Tips

Recent enhancements to the Claims Processing System have automated the processing of many claims. The following tips on billing formats will help to ensure that your claims are processed correctly, and in a timely manner.

Note Records

When MSP provides instructions to submit claims with a specific note record, use the exact format indicated. For example, the system can now "read" and accept "CCFPP" but it cannot read "C C F PP". The system reads character "strings". Inserting additional spaces between letters in a word or abbreviation makes the note record unreadable by the system and can lead to refusals or payment delays.

Time Service Rendered

The time that the service was rendered should always be used as the "start time" for the claim. If the fee item requires a "time called" according to the Payment Schedule, this information should be provided in the note record.

The following fee items must have a "start time" in the "start time" field of your submissions to be accepted by the system:
01200, 01201, 01210, 01211, 00112
The following fee items must have a "start time" and an "end time" in the appropriate fields of your submissions to be accepted by the system:
01205, 01206, 01207
Although start times are not required on visit fees or weekend call-outs (fee item 01202), or on weekend surgical surcharges (fee item 01212), providing the start times may enable quicker processing of your claims, especially for multiple services on the same day at different times. In these cases, provide the time each service was rendered.

Overview of Fee Items for Emergency Visits and Out-of-Office Hours Premiums

Fee Item	Description	When to Bill
00112	Emergency Visit (call placed between 0800 and 1800 hours)	To be charged only when physician must immediately leave home, office, or hospital to render immediate care.
01200-01202	Call-out Charges	To be billed when the physician is specially called to provide non-elective care to a patient at a different geographic location during out-of-office hours. The call must originate in the designated timeframe and the service must be rendered in the designated timeframe (i.e., 1800-0800 hours, weekends, and statutory holidays). To be charged extra to the consultation or other visit, or extra to the procedure if no consultation or other visit charged.
01205-01207	Non-operative Continuing Care Surcharges	Applicable when an out-of-office hours call-out charge is applicable, or when specially called for an emergency within the designated times. Timing begins after the first 30 minutes of care, and is based on one half-hour of care or major portion thereof.
01210-01212	Operative Continuing Care Surcharges	To be billed in addition to surgical fees or surgical assistant fees for emergency surgical services provided outside regular office hours (i.e. 1800 - 0800 hours, weekends, and statutory holidays).
01800 series	Emergency Care	To be billed when the physician is designated as the emergency physician by the medical staff, and is on hospital Emergency Department duty and on-site.

Note: Information on the Critical Care Coverage Program is provided in a separate module.

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