Reporting requirements - hours, fees and time away from practice

Reporting requirements - hours, fees and time away from practice

The LFM payment model is flexible and allows family physicians to work part- or full time. It’s important to think carefully about how many patients you see each day, how many hours you want to work each week and how much time you’d like to take away from your practice each year before you commit to the LFM payment model.

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.

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 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.

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.

Uncontracted time

Six weeks per year are deemed uncontracted time. This time includes unpaid days for sick time, bereavement leave, educational leave, statutory holidays and vacation days.

Billing LFM hours

To enable billing of submitted (actual) LFM hours, two health service codes (HSCs) have been created:

  • 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:

  1. 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
  2. You can claim your submitted (actual) LFM hours at the premium rate of $139.05 (HEVW1) instead of the daytime rate of $92.70 per hour (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 TIP 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 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.

Next steps