Understanding and optimizing service encounters

Understanding and optimizing service encounters

The LFM payment model requires physicians to perform a minimum of 2.8 service encounters per hour. Service encounters will be averaged quarterly. It’s important that physicians bill all insured services and accurately track their hours.

What is a service encounter?  

In the LFM payment model, service encounters track qualifying medical services. Every patient appointment counts as at least one service encounter. Most MSI-insured, community-based medical services are valued as one or more service encounters.

What qualifies as a service encounter:

  • All patient appointments
  • Pap smear and vaginal/pelvic exams with speculum each count as an extra service encounter, in addition to the service encounter earned for any associated appointment
  • Services with time-based multiples (such as prolonged office visits, counselling, psychotherapy, palliative care support) are valued at 1 SE per multiple
  • Procedures count as one or two service encounters (refer to the LFM Service Encounter Cheat Sheet)
  • Surgical and fracture services
  • Most complex visits are valued as two service encounters, including:
  • NPIV1
  • Palliative care support visits (03.03C)
  • Comprehensive visits (03.04)
  • Gender readiness assessments (03.04K GAC)
  • Initial opioid agonist treatment (OAT) codes (03.03J, 03.03K,03.03L)
  • Comprehensive GP consultations (03.08)

What does not qualify as an extra service encounter:

  • Insured injections and immunizations do not qualify as an extra service encounter when billed with an office visit
  • NSH interpreter (ADON OFI1)
  • Yearly CDM incentive fees
  • Indirect patient care codes, such as Allied Health Care Provider to Physician Discussion (AHCP1), Prescription Renewal (TPR1) and the Teaching Stipend for Medical Student
  • Workers Compensation Board services (paid outside LFM contract)

The definition of LFM service encounters is new and will continue to evolve as data is gathered and physicians provide feedback.

Make the most of each service encounter

  • Delegate work mindfully so that you can achieve the service encounter ratio. For example, delegate some indirect care tasks and components of more time-consuming tasks (such as first prenatal visit history, CDMs, Rourkes), but retain some straightforward service encounters in your own schedule (such as insured stand-alone injection/immunizations and suture removals).
  • Bill all insured services.
    • Know your fees – especially the codes for prolonged office visits (03.03, 03.03A, NPIV1)
    • Check out the billing education information available on the MSI website
    • Bill for all face-to-face and non-face-to-face visits, and indirect services like Allied Health Care Provider to Physician Discussion (AHCP1), Prescription Renewal (TPR1) and Physician to Physician Advice (03.09L)


Next steps