All APP physicians must be accountable for the services they deliver. The accountability framework requires consistent shadow billing and the completion of an Annual Activity Report and a Leave of Absence Summary.

Shadow billing

All APP physicians are required to shadow bill and are subject to audit. Accurate and comprehensive MSI billing is essential.

Annual Activity Report

The Annual Activity Report allows APP physicians to describe the work they do that is not shadow-billable.

These activities include clinical care activities that don’t have health service codes attached to them, such as screening clinics, remote or non-face-to-face patient care, patient advocacy and collaborating with other health professionals. 

Physicians should also report on the clinical support work they do, including implementing and administrating their practice’s EMR, developing and maintaining standards of care or clinical practice guidelines, and participating in Nova Scotia Health (NSH) or Department of Health and Wellness (DHW) initiatives or committees. Capacity-building (such as continuing professional development, journal clubs and mentorship) also falls into this category.

Leave of Absence Summary 

Physicians are also required to submit an annual Leave of Absence Summary. 

Physicians on full-time APPs are paid for 46 weeks per fiscal year. The remaining six weeks (unpaid) are to be used for sick leave, vacation time, continuing professional development (CPD) or the 12 annual statutory holidays. All absences must be reported on the Leave of Absence Summary.

If you choose to take a statutory holiday and don’t want to use an unpaid/vacation day for it, you may choose to work a day in lieu. Lieu days must be scheduled in advance and may include after-hours or weekend clinics, hosting patient information sessions or completing INRs. Physicians may also choose to do paperwork or other clinical services support work during this time.

Supporting documentation

It’s important to be able to verify the claims you make on your Annual Activity Report and Leave of Absence Summary. The accountability framework (also known as the deliverables document) that accompanied your contract specifies how you should document the hours you spend doing work that is not shadow-billable. Generally, it’s sound policy to record your work in your EMR; keeping a written record (such as a calendar or daybook) is also a good idea. 

Process and deadlines

All reports are due within 30 days of the end of the fiscal year. As the reports must be submitted to the NSH for signature before they are submitted to the DHW, it’s best to complete the reports promptly. Be sure to follow up with the NSH to ensure your reports are submitted to the DHW in a timely fashion. If you have trouble connecting with your NSH contact, submit your report directly to the DHW.

Why bother?

Submitting an activity report is a contractual obligation for all APP physicians, but there are other reasons to do so. These reasons include:

  • Demonstrating the full extent of the demands on physicians in comprehensive family practice. 
  • Providing documentation in case your file is pulled for review. If your shadow-billings are coming up short, but you’ve filed a comprehensive activity report, it will be easy to demonstrate how the services you provide have affected your shadow-billing. 
  • Ensuring you receive the full amount of contractual funding to which you are entitled. 

Be sure to submit your Annual Activity Report and Leave of Absence Summary by April 30 each year. 


Jennifer Girard
Physician advisor (Zone 4-Central)
Ryan Brown
Physician advisor (Zones 2-Northern and 3-Eastern)
Noelle Moulaison
Physician advisor (Zone 1-Western)