Contracted hours worked
Physicians project the number of hours they will work each year, spread over 46 weeks, as part of their LFM contract. This projection is called “clinical working time” and these are your “contracted hours.” The hourly component of your biweekly paycheque for the next year is based on this projection.
Contracted hours include all work with panel patients, except the following: uninsured services, MAID, third-party
services including WCB, and when providing services that are paid under other provincial funding models, such as hospitalist work, CHIP, Primary Maternity Care and emergency department coverage.
Do not claim hours for clinical support services that are not patient-specific but provide benefit to the patient population and the health system, such as meeting with your admin team to rearrange your schedule or spending time ordering new equipment. These hours are paid as a 10% top-up to your weekly contracted hours.
When calculating your contracted hours, remember to exclude a daily lunch break if you typically take a non-working lunch. If you don’t take a lunch, or if you do paperwork or provide indirect patient care while you eat your lunch, you can include that time in your contracted hours.
Actual hours worked
Submitted (actual) hours worked are claimed daily and include clinical work that is both direct and indirect patient care.
- Direct: Any visit with a patient (face-to-face or virtual) that is insured by MSI.
- Indirect: Specific patient care where the patient isn’t engaged in an encounter with you, for example, any necessary discussion with or advice to a patient’s family/caregivers; charting; prescribing medication or therapy; arranging diagnostic services; writing or arranging referrals; reviewing labs, diagnostic images, consult or OR reports; and updating the patient’s chart, as appropriate. This time also includes consulting with other physicians or allied health-care providers regarding the management of your patient.
Physicians should claim actual clinical working hours daily, 365 days per year – while always being mindful of the need to bill an average of at least 2.8 service encounters per hour. Depending on your practice efficiency (service encounter ratio), you may or may not be able to bill all working hours.
IMPORTANT: You can only bill hours worked for time you actually spent providing direct or indirect patient care. You cannot wait to see how many encounters you saw in each day or week, and then calculate how many hours you feel you “should” bill. Your daily hours should be billed at the same time as your daily encounters. If you’re concerned you will overbill indirect time and not meet the 2.8 SER requirement, you might choose to hold back on submitting your hours. If you do that, you should keep track all hours worked for reference when going back to bill your hours. Best practice, however, is to bill your hours with your service encounters to mitigate risk of audit.
Annual reconciliation of hours
Once a year, around July 1 (90 days after March 31, the end of the DHW’s fiscal year) the DHW will reconcile LFM physicians’ submitted (actual) hours worked with their contracted hours as per the Schedule A – Contracted Activities form they submitted with their contract.
The hourly component of each biweekly LFM payment is based on the contracted working hours in each physician’s contract. The reconciliation will use billing data to assess whether the submitted (actual) working hours claimed align
with the hours paid based on the contracted hours. If the physician has met the 2.8 SER and worked more than their contracted hours, they will be paid for the extra hours after the reconciliation. If they’ve worked less, the money must be repaid; repayment terms will be arranged with the DHW on an individual basis.
IMPORTANT: It is crucial all LFM physicians review their LFM Quarterly Reports from the DHW so they are not surprised. If you read your report, you will be aware of how you’re tracking and likely have time to adjust so you do not end up owing money back to the government at the end of the year.
Expected hours per year
Physicians are expected to work 46 weeks per year, but payments will be smoothed over 52 weeks (or 26 pay periods). The DHW expects physicians who are planning to be away from clinical work for more than two weeks to make every reasonable effort to ensure necessary medical coverage for their patients.
Week defined
OFFICE: Physicians are expected to work 46 weeks per year, but payments will be smoothed over 52 weeks (or 26 pay periods). Under the LFM con-tract, a “week worked” is defined as any week (Sunday to Saturday) where a physician provides 40% of their “targeted service encounters.” An individual physician’s target service encounter rate is defined as the number of contracted hours per week multiplied by 2.8 (minimum service en-counter rate per hour). For example, if a physician is contracted for 40 hours per week, their target service encounter rate is 112. That means that to meet the 2.8 minimum SER, they would need to provide at least 112 service encounters each week. The DHW knows not all weeks wind up looking the same so they call it a “week worked” if a physician has seen 40% of their target service encounters. In this example, 40% of 112 is 44.8 service encounters. This adjusts for unexpected things that pop up during the week that may interfere with a physician’s typical schedule. Physicians will still need to make up the hours for which they were paid during that week that they didn’t work, but they will have satisfied the expectation of working 46 weeks per annum.
SYSTEM: If you’re an LFM physician that meets the 46 weeks of work per annum doing work across the system (for example, hospitalist, CHIP, PMC, ED) not just in your LFM office, a “week worked” is defined by hours. In these cases, a week worked is defined as whether or not the hours you provided and were paid for in the “other” service area is equal to 40% of your weekly contracted LFM hours. In the same example outlined above, if you’re a physician who is contracted for 40 hours per week in your LFM practice across five days for eight hours per day, then as long as you provide two days or 16 hours (40% of five, eight-hour days) of service in the other service area, you’ve satisfied a week of work. The DHW tracks LFM physician weeks worked (both inside and outside the model) and will reconcile it at the end of year.
Uncontracted time
Physicians are entitled to six weeks per year of uncontracted time. This time includes unpaid days for sick time, bereavement leave, educational leave, statutory holidays and vacation days. Although away from practice, physicians will still receive their biweekly base pay (hours and panel amount) during this time off. If the DHW finds during the annual reconciliation process that after applying the 40% calculation outlined above, a physician took more than six weeks of uncontracted time, they will recover the physician’s panel payment allocation for the number of weeks of uncontracted time over and above the allowable six weeks and there may be contractual consequences.
Billing LFM hours
When billing your LFM hours, you must first remember to only use your Hourly Business Arrangement (BA) Number. This number has been issued to you specifically to bill your LFM hours. If your hours are billed to the wrong BA they will not get counted toward your hours worked. You must also use the appropriate health service codes (HSCs).
- HDAY1 – This is the hourly fee code for clinical daytime hours worked, billed at the daytime rate, that is, not eligible for the GPEW premium. This is also the appropriate code to bill for paperwork done during evenings or weekends when there are no concurrent visits.
- HEVW1 – This is the hourly fee code for clinical evening/weekend/holiday hours worked, billed at the premium rate, that is, eligible for the GPEW premium.
To facilitate billing submitted (actual) hours as a fee code, MSI has created a “mock patient.” The mock patient demographics and diagnosis are:
- Health Card Number 0015800568
- DOB April 1, 1969
- Diagnostic code V689
TIP: Many physicians find it useful to book this mock patient at the end of their daily schedule as a reminder to bill their submitted (actual) LFM hours when the work day is complete.
To bill your submitted (actual) hours worked, enter the number in the “units” box of the claim (for example, 8.5 daytime hours = 8.5 units). Each provider can only bill one HDAY1 and one HEVW1 claim per day. Round submitted (actual) hours to the nearest 15-minute increment.
Physicians must bill their submitted (actual) hours under their LFM Hourly Business Arrangement (BA) Number.
Because these claims are strictly for tracking purposes, the LFM hourly HSC pays $0. Reporting the hours you worked under this HSC enables reconciliation at the end of the year. For more complete billing guidelines, refer to the MSI Physician’s Bulletin from Oct. 27, 2023.
Billing premium rates
Physicians will bill HSCs GPEW and HEVW1 for premium rates for early morning, evening, weekend and holiday visits (direct clinical services) with patients. These visits can be face-to-face or virtual. The premium available under the LFM for this after-hours work is two-fold:
- You can bill the GP Enhanced Hours Premium (TI=GPEW) for all eligible services you provide, which adds a 25% premium to the MSU value for the visit billed, and
- You can claim your submitted (actual) LFM hours at the premium rate (HEVW1) instead of the daytime rate (HDAY1).
The premium rates (GPEW and HEVW1) can be billed for work conducted Monday to Friday between 6 and 8 a.m. and 5 and 10 p.m., and on Saturdays, Sundays and holidays. Remember that after-hours paperwork (that is, indirect patient care) cannot be claimed at the premium rate (HEVW1) unless direct patient services (visits) are provided during that hour. If no direct patient care is provided, the hour should be billed at the daytime rate (HDAY1).
TIP: Consider adding early morning, evening and weekend appointments to your clinic hours – scheduling more patients during GPEW and LFM premium hours boosts compensation and creates better access for patients. For example, choose one day per week to book six patients for 10-minute appointments from 7 to 8 a.m. or 5:30 to 6:30 p.m.
Part-time work and unexpected leaves
Under the LFM payment model, physicians are contracted to work 46 weeks per year. Physicians may work part time or extended hours each week, however, they must be accessible to their practice and patients (virtually and in-person) for 46 weeks of the year. The LFM is not an appropriate model for physicians who intend to take extended time away from their office-based family practice.
Exceptions will be made for physicians who are unable to be in their office practices for 46 weeks due to other approved clinical work, such as hospitalist work, Primary Maternity Care (PMC) or emergency department coverage. These specific arrangements will be determined on a case-by-case basis as part of your contract discussion.
If a physician will be absent for more than six weeks in a year, 30 days’ notice must be given to the DHW and NSH by emailing LFMfunding@novascotia.ca. Parental leaves and extended absences due to unforeseen circumstances (that is, medical leave) will be approved. Your LFM model will be paused or terminated depending on your unique circumstances.