Fee Navigator®

    Governing Rule: 19

    DAILY PATIENT VOLUME PAYMENT RULES

    • 19.1

      Daily patient volume payment rules will apply to visit services with a "V" category code (excluding HSC 13.82A) that are provided in an office, home, or a non-registered facility.

      The codes activated during a pandemic by the Chief Medical Officer of Health will be exempt from the daily patient volume payment rules.

      Excluding Grande Prairie and Fort McMurray, the daily patient volume payment rules will not apply to services provided in communities that are eligible for variable fee payments under the Rural Remote Northern Program.

      The total of all billings for eligible category "V" codes that are accepted for payment under the Alberta Health Care Insurance Plan will be calculated for each practitioner for each calendar day. When the daily total exceeds 50, the practitioner's payment on the category "V" codes that exceed 50 will be discounted by 50 percent. When the daily total exceeds 65, the practitioner's payment on the category "V" codes that exceed 65 will be discounted by 100 percent.

      Services will be assessed and payment/discounts will be applied to services in the order in which they are accepted for payment by the Alberta Health Care Insurance Plan.

    • AMA billing tips:

      • Alberta Health has added the location of HOME as well as unregistered facility i.e. location code OTHR to the list of locations that will have the daily cap applied to them.