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  • Complexity modifiers | Alberta Medical Association
    the paperwork Resident Physicians Medical Students Membership Guide Manage your membership Patients First Advocacy timeline Health issues Prescription Alberta Many Hands Physician Advocacy Immunization Other Patient Health Matters albertapatients Forms Website and login help Media Publications Member Sign in AMA member number Password Forgot your password Login help Alberta Medical Association Member Sign in AMA member number Password Forgot your password Login help About the AMA Leaders Partners Member services Patients First Home Member services Physicians Compensation and billing Billing help Billing tips Complexity modifiers Complexity modifiers Complexity modifiers may only be billed for the time spent on management of the patient s care for the total time spent providing the time was spent on the same day the patient was seen For example Day one Physician reviews chart sees patient completes referral letter on the same day Total time spent managing patient care 35 minutes Therefore the complexity modifiers CMXV15 CMXV20 CMXV30 CMXV35 CMGP OR CMXC30 as appropriate may be claimed in addition to the visit service Day one Physician reviews chart and sees the patient Total time spent 25 minutes Day two Physician completes referral letter Total time spent 10 minutes The time spent completing the referral letter may not be included in the time spent on day one the physician may only claim for 25 minutes of time Website feedback Member services Physicians Our Agreements Compensation and billing Billing help Schedule of Medical Benefits Online Billing Advice Billing tips How to bill for major portion thereof Lacerations 98 22A and 98 22B Goals of Care forms Dental pre op and related services After hours work over 2016 stat holidays WCB report fee adjustments coming April 1 and July 1 2016 Billing seminars Compensation programs Uninsured services Allocation Alternative Relationship Plans ARPs Economic indicators WCB Physician and Family

    Original URL path: https://www.albertadoctors.org/services/physicians/compensation-billing/billing-help/billing-tips/complexity-modifiers (2016-02-01)
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  • Transfer of Care modifier | Alberta Medical Association
    albertapatients Forms Website and login help Media Publications Member Sign in AMA member number Password Forgot your password Login help Alberta Medical Association Member Sign in AMA member number Password Forgot your password Login help About the AMA Leaders Partners Member services Patients First Home Member services Physicians Compensation and billing Billing help Billing tips Transfer of Care modifier Transfer of Care modifier The Transfer of Care TOC modifier is applied to claims for hospital daily care 03 03D on the date of service that the patient is being transferred Both the receiving physician and the transferring physician may submit claims for the same patient on the date of transfer However the TOC modifier is only added to 03 03D claims by the physician who is taking over the care The TOC modifier demonstrates the need for two 03 03D claims on the same date of service 03 03D is not billable for routine post operative care within the inclusive care period of the procedure Specialists such as internal medicine have their own TOC codes and should continue to use the TOC codes that are applicable to their specialty If the transferring physician does not submit a 03 03D on the day of transfer the receiving physician does not need to add the TOC modifier For more information see the Online billing advice website section log in required For more advice from AMA staff on any billing issues including explanations of recent billing changes please email AMA billing staff Website feedback Member services Physicians Our Agreements Compensation and billing Billing help Schedule of Medical Benefits Online Billing Advice Billing tips How to bill for major portion thereof Lacerations 98 22A and 98 22B Goals of Care forms Dental pre op and related services After hours work over 2016 stat holidays

    Original URL path: https://www.albertadoctors.org/services/physicians/compensation-billing/billing-help/billing-tips/transfer-of-care-modifier (2016-02-01)
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  • Documentation is important | Alberta Medical Association
    First Advocacy timeline Health issues Prescription Alberta Many Hands Physician Advocacy Immunization Other Patient Health Matters albertapatients Forms Website and login help Media Publications Member Sign in AMA member number Password Forgot your password Login help Alberta Medical Association Member Sign in AMA member number Password Forgot your password Login help About the AMA Leaders Partners Member services Patients First Home Member services Physicians Compensation and billing Billing help Billing tips Documentation is important Documentation is important The Alberta Medical Association AMA would like to remind physicians to keep and maintain proper documentation for all patient encounters Alberta Health s Program Monitoring and Compliance unit has advised that many physicians undergoing review have inadequate records The following suggestions should help with this task Buy a small book and pencil and keep them with you at all times You can then easily track and record phone calls with various providers This will also serve as a log for billing purposes Keep track of the times you speak with facility staff these calls are very often not recorded in the chart at the facility Record every encounter with a patient in the patient s chart including visits billed on a cumulative time basis This way you will record all callbacks and multiple encounters on the same day and these will be reflected accurately in the chart if there is an audit or billing review Website feedback Member services Physicians Our Agreements Compensation and billing Billing help Schedule of Medical Benefits Online Billing Advice Billing tips How to bill for major portion thereof Lacerations 98 22A and 98 22B Goals of Care forms Dental pre op and related services After hours work over 2016 stat holidays WCB report fee adjustments coming April 1 and July 1 2016 Billing seminars Compensation programs Uninsured services

    Original URL path: https://www.albertadoctors.org/services/physicians/compensation-billing/billing-help/billing-tips/documentation-PCA-billing-tip (2016-02-01)
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  • How to claim for additional compensation EMSAF | Alberta Medical Association
    Services Assessment Fund EMSAF According to Governing Rules 2 6 benefits may be claimed in excess of those listed in the SOMB for services involving unusual complications or care Requests for increased compensation require additional documentation either an operative report or other detailed description of the care to support the claim To submit a claim for additional compensation First consider if the claim is reasonable Did the procedure have unusual complications that contributed to the increased level of time or intensity Did the procedure require significantly more time than the average for this procedure Consider how much additional compensation you will request Prepare a letter that summarizes your request and rationale as to why this claim should be considered for additional compensation Locate the operative report and prepare for faxing Enter the claim information as usual using the Health Service Code and patient demographic information Check the EMSAF indicator box of the claim you may have to contact your software provider to find out where this is located in your program You will also enter text on the claim that states you are requesting additional compensation for the claim and state the amount you are requesting If you do not check the EMSAF indicator box your claim will not enter into the queue for additional compensation Once you have submitted the claim your software will provide you with a claim number Record the claim number on the top right hand corner of the letter and all pages of the operative report Fax the letter and the operative report to 780 422 3552 The claim will appear on the next Statement of Assessment from Alberta Health as paid at the listed rate Do not be alarmed the additional compensation may be paid after the Additional Compensation Committee reviews the claim Typically

    Original URL path: https://www.albertadoctors.org/services/physicians/compensation-billing/billing-help/billing-tips/additional-compensation-EMSAF (2016-02-01)
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  • New investigation unit will tackle AHCIP claims and services | Alberta Medical Association
    investigation unit will tackle AHCIP claims and services The Special Investigations Unit SIU of Service Alberta has been engaged by Alberta Health AH to assist in the investigation of claims and services paid for by AH pursuant to the Alberta Health Care Insurance Plan AHCIP and Government of Alberta drug plans administered by AH The SIU will carry out investigations concerning fraudulent and inappropriate activities in the following areas Practitioners professional AHCIP claims and prescribing practices Dispensing practices by pharmacists and pharmacies The provision of insured health services to non insured patients The suspicious use of health cards or personal health numbers Any other health services provided to an individual to determine illegal or fraudulent activity including but not limited to the trafficking of prescription drugs The SIU has been created under a special agreement between AH and Service Alberta The partnerships between the two ministries join the law enforcement experience of Service Alberta s SIU with the technical knowledge and expertise of AH s Monitoring and Investigations Branch The current claims reassessment process remains the same and will continue to be a responsibility of AH For more information on the SIU please call their general information line at 780 441 2000 or toll free within Alberta at 310 0000 and then 780 441 2000 Website feedback News News archives October 2015 September 2015 August 2015 July 2015 June 2015 May 2015 April 2015 March 2015 February 2015 January 2015 December 2014 November 2014 October 2014 September 2014 August 2014 July 2014 June 2014 May 2014 April 2014 March 2014 February 2014 January 2014 December 2013 November 2013 October 2013 September 2013 August 2013 July 2013 June 2013 May 2013 April 2013 March 2013 February 2013 January 2013 December 2012 November 2012 October 2012 September 2012 August 2012 July 2012

    Original URL path: https://www.albertadoctors.org/news/news-archives/new-SIU-unit-AHCIP-claims (2016-02-01)
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  • Tobacco cessation | Alberta Medical Association
    of Alberta government sponsored supplementary health plans are eligible to receive coverage for Champix Varenicline Tartrate This coverage is a restricted benefit Eligible plan members are 18 years of age and older On a government sponsored supplementary health plan Enrolled in an Alberta Health Services AHS tobacco cessation program AlbertaQuits Helpline and or AlbertaQuits Groups Any member of the Alberta government sponsored supplementary health plans who wishes to quit tobacco using Champix must show proof of enrolment in an AHS tobacco cessation program in order to fill a prescription The individual must follow these steps in order to get the prescription initially and to receive subsequent refills The individual will visit his her physician to receive a prescription for Champix In addition to providing the patient with a prescription the physician will refer the patient to an Alberta Health Services tobacco cessation program The patient will enrol in an AHS tobacco cessation program The patient will request an intervention form from the tobacco cessation program The patient will present the form to a pharmacist and receive up to a four week supply of Champix medication Initially a single starter pack is allowed Prior to each prescription fill renewed on a four week basis the patient must request a letter of confirmation of continued enrolment from the tobacco cessation program The patient will provide his her pharmacist with the prescription and the letter of enrolment when having the drug refilled and will repeat steps 5 and 6 for continued tobacco cessation therapy Three forms have been created to assist health care professionals and patients Health care Professional Information for Prescribing Champix varenicline tartrate for Subscribers of Government Sponsored Supplementary Health Plans Form 1 is intended to be used by physicians and provides detailed information on who is eligible for this initiative

    Original URL path: https://www.albertadoctors.org/services/physicians/compensation-billing/billing-help/billing-tips/tobacco-cessation (2016-02-01)
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  • Billing for patients in a designated assisted living and assisted living facility | Alberta Medical Association
    AMA member number Password Forgot your password Login help About the AMA Leaders Partners Member services Patients First Home Member services Physicians Compensation and billing Billing help Billing tips Billing for patients in a designated assisted living and assisted living facility Billing for patients in a designated assisted living and assisted living facility If the physician visits the patient in their individual living quarters within the designated assisted living DAL or assisted living AL facility claims may be submitted using the home visit codes 03 03N Home visit If there is only one person living in the individual living quarter physicians would claim 03 03N Each individual living unit is considered a separate and distinct home Therefore each time a physician visits a patient in their living quarters 03 03N should be claimed The location code should be HOME for this type of service The CMGP modifier can be added to the claim as appropriate 03 03P Home visit second subsequent patients If there is more than one person living in the individual living unit the claim for the second subsequent patients seen in the unit should be submitted using 03 03P The location code should be HOME for this type of service The CMGP modifier can be added to the claim as appropriate If space is provided by the DAL or AL facility where a physician can see patients the physician should claim an office visit 03 02A 03 03A or 03 04A as appropriate to the service provided with appropriate modifiers The location code on these types of claims would be OTHR unless the facility has a registered office space with Alberta Health Website feedback Member services Physicians Our Agreements Compensation and billing Billing help Schedule of Medical Benefits Online Billing Advice Billing tips How to bill for

    Original URL path: https://www.albertadoctors.org/services/physicians/compensation-billing/billing-help/billing-tips/patients-in-assisted-living (2016-02-01)
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  • Claims for newborns | Alberta Medical Association
    Many Hands Physician Advocacy Immunization Other Patient Health Matters albertapatients Forms Website and login help Media Publications Member Sign in AMA member number Password Forgot your password Login help Alberta Medical Association Member Sign in AMA member number Password Forgot your password Login help About the AMA Leaders Partners Member services Patients First Home Member services Physicians Compensation and billing Billing help Billing tips Claims for newborns Claims for newborns When a claim for care of healthy newborn 03 05G is submitted it is billable once per patient It is the only service that may be submitted to Alberta Health and Wellness AHW regardless of how many days the baby is in the hospital with the mother If the baby is born ill a claim for daily care 03 03D may be submitted to AHW for the total number of days the patient required daily care If the baby is born well and suddenly becomes ill and a claim for care of healthy newborn has already been submitted the 03 05G claim should be changed to 03 03D Visits related to the illness should be submitted using HSC 03 03D until the patient is discharged If one physician has submitted the claim for care of healthy newborn 03 05G and another physician is performing daily visits on the baby regardless if the baby is ill or not no claim for daily visits may be submitted by the second physician Website feedback Member services Physicians Our Agreements Compensation and billing Billing help Schedule of Medical Benefits Online Billing Advice Billing tips How to bill for major portion thereof Lacerations 98 22A and 98 22B Goals of Care forms Dental pre op and related services After hours work over 2016 stat holidays WCB report fee adjustments coming April 1 and July 1

    Original URL path: https://www.albertadoctors.org/services/physicians/compensation-billing/billing-help/billing-tips/newborn-claims (2016-02-01)
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