How is the panel/roster size calculated?
When calculating physician panels, the DHW considers the New Patient Intake Visit (NPIV1) code and the ME=CARE modifier.
- Use of the NPIV1 code immediately roster a patient to your panel.
- The ME=CARE service modifier billed over time also rosters a patient to your panel.
If you are taking a patient over from a retiring or downsizing physician, bill NPIV1 when you complete your intake visit with the new patient to move them from the other provider’s patient roster to yours. For further information on roster size calculations, taking over patients from another provider or the 811 Need a Family Practice registry, please contact your physician advisor.
Panel size is calculated dynamically and smoothed for payment every quarter to account for additions to your practice as well as inactive patients who have died or moved out of province. Refer to the LFM FAQ or contact your physician advisor.
Your panel payment
Panel payments are smoothed into your biweekly paycheque. Bill the NPIV1 code when accepting a new patient into your practice, including for newborn babies.
How are my “healthy unseen” patients counted?
The DHW understands that physicians have a number of “healthy and unseen” patients in their practice. To account for this, an additional 10% is added to your calculated panel size.
How are patients removed from my panel?
A patient will be removed from your panel if they die or if they are formally taken on by another physician (if that physician bills NPIV1 or has seen the patient consistently and more often than you over time). The NPIV1 is weighted very heavily at the onset but decreases over time, allowing a patient to be removed from your panel if they are seen more often by another physician.
What is ME=CARE?
ME=CARE is a fee code modifier that pays physicians a premium on most office-based billing codes when seeing a rostered/attached patient. Physicians must commit to providing ongoing comprehensive primary health care to that attached patient to claim ME=CARE. ME=CARE can be billed for a patient of another provider within your collaborative practice group.
What about patients who receive prenatal care outside of my practice?
Prenatal care codes are not accounted for in the ME=CARE attachment algorithm, so the patient will remain on your panel.
Community complexity modifier
The LFM payment model includes a community complexity modifier to account for variations in socio-economic status factors in different communities. This calculation is currently based on your community of practice, but work is being done to provide a more accurate calculation that would reflect the actual medical complexity of your specific patient panel. This is still under development. Currently, the complexity modifier is applied automatically to your panel and hourly payments and smoothed into your biweekly payments. The community complexity modifier is paid as a quarterly premium on your 30% FFS claims.
How to request a panel validation
Physicians may participate in a panel validation exercise to receive a report comparing their panel size as calculated by their EMR patient count and the panel size as calculated by the ME=CARE/NPIV1 algorithm. Email LFMfunding@novascotia.ca to request a panel validation. Consider hiring a third-party biller or billing expert to help you bill appropriately. Contact your physician advisor for options.
Physicians are responsible for all claims
You are responsible even when claims are entered by someone else, such as billing staff. MSI is the ultimate authority on physician billing. If you have questions about billing under the LFM, email MSI and save the response for audit purposes.
More tips for billing success
- Bill submitted (actual) hours worked, including paperwork time, but keep an eye on your service encounter ratio. Make sure to distinguish between daytime (non-premium) (HDAY1) hours and premium (HEVW1) hours.
- Billing hours daily (or when you bill your FFS billings) is best practice. Do not delay billing your submitted (actual) hours worked. Use calendar reminders to make sure you don’t forget and consider using an app to help track your submitted (actual) hours worked.
- Consider using your EMR to help you log times. In Med Access, use the “Memo” feature at the top of your daily schedule to log your start/end times for every work session.
- Remember that EMR data can be easily accessed to see every click you make and when you made it. This information can help you track your submitted (actual) LFM hours if needed. Refer to your cell phone call log for phone call durations.
- Get in the habit of time-stamping all encounters – for example, if you realize you had a patient encounter that will be billed to Veteran’s Affairs or WCB NS, you’ll need to subtract it from your actual hours worked. Find the times by checking the time stamps on the visits straddling that encounter. When the visits on either side of it were time-stamped, the calculation is easy to do.