Intro to GPSC Fees

Dr H Kluge

May 13, 2015

Victoria Division of Family Practice

Some Quick Math

• beware the 0100• you would have to see 34 pts

per day in order to bill MSP $1000

• by 50 pts, you've only made $1500

• max you can bill this way is $1650

• Avg overhead is 25-30% of your billings

• $1500 = $1050

• $1000 = $700

General Practice Services Committee (GPSC)

• A GP for Me/Attachment initiative• GPSC was formed in 2002 as a partnership between the BC Ministry of Health (MoH)

and Doctors of BC.

• "encourage and enhance" full-service family practice to the benefit of patients

• help increase access to primary care, strengthen continuous doctor-patient relationships

• http://www.gpscbc.ca/billing-fees/billing-guide-tutorial

• Full-service Family Practice (FP) Incentive Program

Mrs. D

• 82 year old lady with diabetes, COPD and Parkinson‘s disease

• DM and COPD are her active conditions

• review symptoms, meds and specialist follow-ups

• COPD action plan• standing order for labs• pneumovax

Complex Care Plan (14033)

• specifies a clinical plan

• detailed review of the case/chart and of current therapies

• face-to-face visit with the patient

• billable once per calendar year for the upcoming treatment year (prospective billing)

• $315 plus office (18100) visit or physical fee (18101)

COPD Action Plan (14053)

• Annual chronic care bonus billable on the anniversary of the commencement of care

• must give them a copy of the action plan

• review and/or adjust the action plan at each subsequent meeting

• $125

Mrs. D

• calls to tell you that she has been coughing in the morning more

• now bringing up dark green sputum

• wants to know what to do....

Telephone Conference Fee (14076)

• telephone call with ANY patient or their family

• must discuss issues relevant to treatment NOT including prescription refills or notification of referrals

• max 500 per year

• $15 each

Mrs. D

• seen in September for her flu shot• review of her DM management

• A1C, BP• diabetic foot exam, cardio and resp exams

• Annual DM Chronic Care Bonus ($125) + CPX($100)• pitfalls

• cannot bill a vaccination• cannot bill HTN Bonus

$725.67 > $90.38

Mr. F

• 52 yo therapist with HTN, ex-smoker

• married with two children

• very little spare time for exercise

• chat about lifestyle, take BP and refill his meds

Personal Health Risk Assessment (14066)

• risk assessment and planning visit• review current risk factors and guidelines based on age, sex• encourage prevention of chronic disease in high risk populations

• Risk factors:• Smoking (786)• Obesity (783)• Inactivity (785)• Unhealthy diet (783)

• Once per calendar year per eligible patient to max 100 per year• $50 each plus office visit - BILLABLE BY LOCUMS

Mental Health Planning Fee (14043)

• patients living in the community with a confirmed Axis I diagnosis of sufficient severity and acuity to warrant the development of a management plan.

• must be 30 min face to face

• if longer than 30 min, may also bill 00100 or 00120 (if over 50 min and fulfills preamble req for counseling)

• allows you to bill an additional 4 counseling sessions in a calendar year

A few other tricks to have up your sleeve...

Telephone Fees

• GP Telephone Urgent Telephone Conference with a Specialist/GP with Specialty Training (14018)

• Conversation within 2 hours of the GP’s request for the development and implementation of a care plan within the next 24 hours to keep the patient stable in their current environment.

• Must be physician to physician communication

• $40

New Attachment Conference Fee (14077)

• specialist or allied health professional

• Can be telephone or in-person conference

• Conference does not need to be with 2 other health professionals, can now be with only 1 other health professional.

• Care plan must be recorded in the chart and include the following information: DX:, Reason for need of Clinical Action Plan, Health Care Providers with whom you conferred & their role, Clinical Plan, Pt risks, goals, refs& F/U, start & stop time.

• Billable on any patient for whom FP is community MRP.

• $40 per 15 minutes or greater portion thereof up to max 18/calendar year per patient. Max 2/day

Unattached Complex Pt Attachment Fee (14074)

• Unattached high needs patients who do not have a family doctor ($200)• Must commit to provide ongoing, longitudinal continuity of care for at least one year

• Patient must be referred (acute care, mental health/substance use workers/clinics, HCC, BCCA, public health, colleagues, local division.

• Billable in addition to visits on same day.

• All complex care codes and chronic care codes are applicable after patient has been accepted into practice and all requirements have been met.

Tips & Tricks

• Urinalysis (15130): $2• Pregnancy test (15120): $11.07• LN2 (0190) in addition to an office visit = billable at 50% PLUS mini tray

fee (40)• Home visit (0103) 0103: $110.26• Nursing home visit if called (115): $110.26• INR management (043): $6

Before You Locum

• Do some research

• Ask about billing

• split

• uninsured forms

• GPSC billing