What services are included in and excluded from the LFM payment model?
It’s important to know what is included in the Longitudinal Family Medicine (LFM) payment model as well as what is excluded and what’s optional. Services that are not included in the LFM can be billed separately, outside of your LFM hours.
Included
- Most insured services for patients in your panel
- Services for out-of-province patients (DHW pays the physician and recovers the fee code amount from the relevant province)
- Chronic Disease Management (CDM), paid at 30%
- EMR envelopes B and C are included in the LFM, so there is no longer a need to apply for these incentives
- Note: It is anticipated that the Collaborative Practice Incentive Program (CPIP) will be paid at 30% once it’s converted to fees, but details are being finalized with Fee Committee
Excluded
- Non-insured services (including third-party, medico-legal, insurance, out-of-country services), including work for Workers Compensation Board of Nova Scotia, Community Services, Province of Quebec
- Hospital-based work with an established payment model (including hospitalist, surgical assists, primary maternity care and emergency department shifts)
- Hospice
- Medical Assistance in Dying (MAID)
- Obstetrical deliveries for both attached and unattached patients
- Honoraria/external committee work
- EMR grant A (new adopters) is payable on top of the LFM
- NSH Committee work and/or meeting time
Optional
Physicians can determine whether they want to bill the following services as part of their LFM agreement or outside it:
- Long-term care/nursing home work
- Under LFM: Can bill hours worked plus 30% FFS and nursing home patients will be included in your panel calculation.
- Not under LFM: Bill 100% FFS; no LFM hours to be submitted for this work. Patients not included in panel.
- Unattached patient work (non ME=CARE)
- Under LFM: Bill hours worked plus 30% FFS. No panel payment.
- Not under LFM: Bill 100% FFS; no LFM hours to be submitted for this work. Reminder: ME=CARE cannot be billed for unattached patients, with the exception of prenatal codes.
Physicians may dedicate some of their 10% clinical support service time to NSH committee and quality improvement work should they have capacity to do so.