General Practice BILLING GUIDE - British Columbia Medical ...

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A GP SERVICES COMMITTEE INCENTIVES • Diabetes Patient Care Flow Sheet Fee item 14050 may be billed after two columns of the flow sheet have been completed. Although you are not required to give the patient a copy of the flow sheet, this is highly recommended to assist in patient self-management by the GP Services Committee. • Congestive Heart Failure Care Flow Sheet Fee item 14051 may be billed once the goals column, initial review (baseline) column, and subsequent column (visit intervals to be determined by the physician) have been completed. Although you are not required to give the patient a copy of the flow sheet, this is highly recommended to assist in patient self-management by the GP Services Committee. • Hypertension Care Flow Sheet Fee item 14052 may be billed after the patient has been provided guideline-based care for one year. To assist in patient self-management, the patient must be given copies of their flow sheet for the year. Flow sheets may be completed retroactively if guideline criteria have been met. The bonus 14052 (hypertension) is not payable if a bonus payment 14050 (diabetes mellitus) or 14051 (congestive heart failure) has been paid for the patient in the preceding 12 months. The bonus 14052 (hypertension) is only billable for care of patients with hypertension who do not also have a diagnosis of diabetes mellitus and/or congestive heart failure. The clinical guidelines summaries are outlined below. The full diabetes care, heart failure care, and the treatment of essential hypertension guidelines are found on the Guidelines and Protocols page of the Medical Services Plan web site, http://www. bcguidelines.ca. 1.5 FlOW ShEETS There are two versions of the patient flow sheets: paper and electronic. Paper: The GPAC paper versions are included in this workbook starting on page E/1 of Appendix i. Should you wish to receive a pad of pre-printed flow sheets, fax your request to the following toll-free fax number: 1-800-952-2895. Additionally, they can be found on the British Columbia Medical Association web site www.bcma.org/log in – member (look under Popular Topics for Members – MSC/BCMA Clinical Guidelines). GENERAL PRACTICE BILLING GUIDE A/3
A GP SERVICES COMMITTEE INCENTIVES Electronic: The CDM Toolkit contains the electronic versions of the flow sheets for CHF, diabetes, and hypertension, and a variety of flow sheets for other chronic conditions. You may register for access to the CDM Toolkit at: http://healthnet.hnet.bc.ca/has/regagree/ 4614fil.pdf. A form is available in appendix i. Other flow sheets can be used if they are consistent with the BC clinical guidelines for diabetes, heart failure, and/or essential hypertension management, and contain the same information included in the patient flow sheets that are part of the BC clinical guidelines. Physicians are not required to submit the completed flow sheets to the Ministry of Health in order to receive the bonus payment. Instead, this program will be subject to the usual process of random audit through the Ministry of Health’s Billing Integrity Program. Therefore, it is important that you keep all of your completed patient flow sheets on file. If you are using the CDM Toolkit, you do not need to maintain paper copies on site but you must be able to produce the flow sheets in the event of an audit. 1.6 FREqUENTly ASKED qUESTIONS 1. When can I claim the condition-based payments? The bonuses are payable if the patient has a confirmed diagnosis of diabetes mellitus (this bonus is not payable for pre-diabetes patients), congestive heart failure, or hypertension. Only one payment per diagnosis is payable per patient per year. Note that effective April 1, 2006, the 14050 and 14051 codes have replaced the 13050 code bonus payments of diabetes and congestive heart failure care introduced under the Full Service Family Incentive Program in 2003, and that code 14052 has been added for hypertension. The codes for claiming the condition-based bonuses are as follows: • 14050 diabetes mellitus • 14051 congestive heart failure • 14052 hypertension The bonus 14052 (hypertension) is not payable if a bonus payment 14050 (diabetes mellitus) or 14051 (congestive heart failure) has been paid for the patient in the preceding year. The bonus 14052 (hypertension) is only billable for patients with hypertension who do not also have a diagnosis of diabetes mellitus and/or congestive heart failure. A/4 GENERAL PRACTICE BILLING GUIDE
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A GP SERVICES COMMITTEE INCENTIVES
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B WORKSAFEBC GP FEES Fee Code Descr
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B WORKSAFEBC GP FEES Fee Code Descr
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GENERAL PRACTICE BILLING GUIDE
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C UNINSURED SERVICES A00073 A Medic
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C UNINSURED SERVICES NOTE: Physicia
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GENERAL PRACTICE BILLING GUIDE
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APPENDIX i FORMS FOR THE GPSC INITI
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APPENDIX ii OTHER TOOLS TO SUPPORT
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APPENDIX iii DIAGNOSTIC CODES QUICK
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APPENDIX iii DIAGNOSTIC CODES QUICK
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