The following are Frequency Asked Questions from the physician/billing community. As additional FAQs are received, answered, and catalogued, updates and additional sections will be added to this page.
General
Do I still shadow bill?
The following response is for all physicians who are compensated through alternate payment methods—that is, not through fee-for-service, but by salary, service contract, or sessional arrangements.
As outlined in the Physician Services Agreement:
- Article 7.1 requires all physicians under Alternate Payment models to submit shadow billing.
- Article 7.2 establishes that this requirement would be in place until at least March 31, 2025, with the possibility of extension.
- Article 7.3 commits the Implementation Management Team (IMT) to developing a plan to reduce the administrative burden associated with shadow billing.
The requirement to shadow bill has now been extended to March 31, 2026, allowing time for IMT to complete its work to streamline service tracking.
Health PEI must collect and share high-quality and comparable data needed to improve services with the Canadian Institute for Health Information (CIHI) in order to be eligible for increased Canadian Health Transfer (CHT) funding. Until a new, streamlined, service tracking solution is implemented, shadow billing is the mechanism by which that data is captured and it is crucial that it be accurate and complete.
If you have any additional questions, please contact the Medical Affairs Office through your Manager of Physician Services.
How do I access overtime?
There will be guidance on this in the Operational Guide in Spring 2025. In the meantime, your physician leader will be able to provide further insight.
What if my billing was not up to date as of March 31, 2025, before the new values took effect?
If you bill through Maximus:
You will have received a software update to install. Once installed, this will update the new fee code values based on the date the service was provided (services provided March 31 and earlier will be billed at the previous rates; services provided April 1 and later will be billed at the new rates).
If you bill through the CHR/EMR:
- The new fee codes* have been updated into the CHR for April 1.
- The old fee codes will be available for 90 days in CHR, to allow for users to catch up on older billings and complete any outstanding reconciliation.
- The old fee codes will only be eligible for submission to Medicare where the service date is prior to April 1.
- Any bill using an old fee code with a service date on or after April 1 will be flagged as ‘Attention Required’ and must be updated with a new fee code prior to submission to Medicare.
*PLEASE NOTE: The new ED fee codes have been submitted to Telus; however, they have not yet been updated in CHR due to the timing and will be included in an upcoming update of the CHR, date TBD, but within 90 days.
If you use billing templates, you need to manually update them. You can hold your bills from April 1 onward (for up to 92 days) until you have a chance to update your billing to the end of March. Once you have updated the billing template, it will submit claims based on the April 1 values. A simple how-to document for updating these billing templates is available for download.
Questions about CHR/EMR billing template updates?
Contact Allan Neumann, PEI EMR Project and eHealth Physician Services Implementation and Change Lead.
Billing/claims questions can be directed to Paula Dingwell-Vos (Manager, Medicare) or Joanne Malone (Physician Claims Education & Monitoring Specialist).
What PHN should be used when billing fee code 1896?
For Fee Code 1896, billers should use PHN 03850609.
LFM
I see that certain codes have a “G” for geriatric premium. What age is this for and is there something that I have to do to get the premium?
“G” is for patients 75 years and older. The geriatric premium is automatically applied based on the healthcare number.
Which code is used for the virtual hallway consultations?
When you are the consulting physician, you would bill 0128. If you are the referring physician, you would bill 1851.
Psychiatry
I noticed the Afterhours premium and geriatric premium. Does the child premium still exist? I thought it was still in the new agreement.
Yes, the Child and Adolescent Psychiatry premium still applies. Preamble 12 D states: A premium of 25% shall apply to the following services provided by a Psychiatrist: psychiatric consultations, repeat consultations, office visits, home visits, and ED visits provided to patients 18 years of age and younger.
Does the weekend premium apply for the consultations?
Consultations do not qualify for the weekend premium. However, consultations qualify for after-hours premiums and the emergency indicator must be ticked and meet the definition of emergency in the Preamble (12 A.3).
We do not use the ED visit codes. As far as I’m aware, we all use the consultations and the psychotherapy codes?
Correct, psychiatry has access to these codes, but most psychiatrists appear to not bill these codes. You can use ED visit codes for visits shorter than 15 minutes or when the consultation for psychotherapy is not appropriate.
The on-call retainer of $600 for PCH, HH, and QEH should be listed. Can you bill for more than one on-call stipend if you are providing the service?
You can bill the on-call retainer for whichever facilities you’re carrying the page for and you can cover multiple facilities during any given on-call shift.
Why are there home visit codes in my billing guide? Is this a premium I can bill?
Every speciality has the ability to bill home visits and LTC, although psychiatrists have not typically billed home visits. These are included in your billing guide to ensure you’re aware. In most cases, psychiatrists will be billing consults or psychotherapy for their visits. However, if the visit is less than 15 minutes, you can bill the home and LTC visits.
A home visit is not a premium; it is a visit. Additionally, home and LTC visits are not timed based visits. Currently, there is no home or LTC visits billed by psychiatrists. You cannot bill home visits and psychotherapy for the same patient interaction.
Medical Subspecialties
There were limits on the amount of use for electronic communication fee codes. Does this exist in the new contract?
There is no limitation on volumes for the new electronic communication fee codes.
Is there still an NP or health care professional collaboration fee?
Yes. 0097 collaborative care is the new code for this.