Changes to SOMB begin April 1

April 1, 2014

As you know, changes to the Schedule of Medicine Benefits (SOMB) begin April 1.

All the changes were outlined in the March 20 Billing Corner . It can be viewed by highlights, sections-specific changes and by those impacting all physicians. You may also download it as a PDF document.

We strongly encourage you to become familiar with the changes as there are new rules which will impact your practice.

We want to take this opportunity to tell you about these changes from a general practice (GP) point of view. Highlights include:

• 03.04A – The comprehensive visit fee code is increasing by almost $10 ($98.78).
• CMGP – Expansion of the CMGP from six units to 10 per patient per visit ($15.56 - small decrease).
• NEW! Long Term Care (LTC) visits now eligible for the complex care modifier (renamed COINPT) for intercurrent illnesses ($39.29).
• 03.03D HD1 and HD2 – Hospital care codes will increase by 20% (HD1=$40.58, HD2=$29.29).
• NEW! 03.01NM – Telephone advice to community pharmacist. You must familiarize yourself with the qualifiers as this is for specific situations only ($12.10).
• NEW! 10.16B and 11.71A – IUD and pessary removal codes. These codes are billable in addition to a visit (10.16B=$13.00, 11.71A=$13.00).
• NEW! 03.05GA (amendment to 03.05G) – Daily care of healthy newborns ($40.58).
• NEW! 03.04Q – Post-surgical cancer surveillance code. You must familiarize yourself with the qualifiers as this code has very specific requirements and work attached to it ($98.78).
• NEW! 03.01O – Physician-to-physician e-consultation, consultant. This code is to encourage the consultant to communicate with you electronically (billable only for the consultant) ($74.18).
• Enhancement – 03.04J - Chronic renal, as defined as Stage 2 chronic kidney disease, is now added to Group A of the Complex Care Plan ($215.52).
• 03.01L series of telephone calls – Although the physician-to-physician phone call rate has decreased, you will now get paid for your time speaking with a community pharmacist.

The sections of General Practice and Rural Medicine executives are aware that there are many different types of family practices. We’ve spoken with many of you and know that changes to the fee codes can dramatically impact you. Some of you have recommended changes and we have tried to implement them to the best of our ability. The requests/suggestions that were unable to be included in this allocation are on our ongoing list of pending items to review.

New general rule (start/end time)

There is a new general rule that all physicians will have to be aware of. Start and end time must be recorded daily for any day you provide a time-based service or modifier. CMGP is a time-based modifier, so if you bill these, you will need to abide by the rule. It is very important to note SGP and SRM were NOT in favor, nor supported the roll out of this rule.

The Alberta Medical Association strongly advocated on our behalf and was successful in getting the rule to recording start/end time once per day instead of recording it for every patient, as was first presented by Alberta Health (AH). The rule is spelled out in the Highlights section of Billing Advice that you will receive in the next few days, but a few points below outline the rule:

• General Rule 2.3.6 – When billing time-based codes including complex modifiers start time and end time for the day must be recorded. (See Highlights in the upcoming Billing Corner for very detailed FAQs on this one). The key points are that:
  • You are required to keep the information in office and not submit it to AH unless asked.
  • You must produce the information in case of an audit.
  • Your billing may not exceed time spent with the exception of services described as a portion thereof etc.
  • Your current electronic medical record may have the capacity to track your time.