cARP After-Hours Billing for Family Medicine Physicians

Family Medicine physicians in Annualized cARP programs will be eligible to claim HSC 03.01AA, in addition to the Family Medicine Annualized ARP base rate for after-hours time when they are on-site in eligible facilities* providing direct patient care or same-day patient care management¹. PPHS will notify programs directly of their eligibility for this additional after-hours compensation.  

Billing Guidance for 03.01AA Claims

For eligible cARP programs, 03.01AA claims must comply with FFS governing rules and payment criteria, as outlined in the SOMB. 03.01AA claims will be submitted using the ARP Business Arrangement and paid to the cARP program at FFS rates.

If you have specific questions about 03.01AA billing and claims, please contact [email protected]  

Eligibility & Limitations

• Claims may only be made for the time the physician is on-site and doing eligible activities in acute care hospitals and long-term care facilities.
• Payable for scheduled and unscheduled services.
• The physician must have seen the patient in person on a given date to claim time for that patient on that date.
• Time may be claimed for direct and indirect patient care activity for eligible patients.
• Care that was initiated by the physician may be claimed.
• Time starts when the physician begins direct or indirect care, not from the time of callback.
• Physicians may not claim overlapping or concurrent time for different patients.
• Standby time or time for breaks may not be claimed.
• Physicians must document their time worked and keep their own record.

*Facilities are defined in the SOMB as hospital inpatient, outpatient and emergency departments, AACCs, UCCs, auxiliary hospitals and nursing homes.

¹Same-day patient care management activities can include review of diagnostics, charting, coordinating care, providing instructions to other members of the care team and other activities related to an individual patient’s care.  The claiming physician must have seen the patient on the date for which time is being claimed.

03.01AA Modifiers

The maximum time claimable is the physician's on-site time, excluding breaks and standby time. Note that while daytime modifiers vary by weekday, weekend and holidays, both night shift modifiers (2200 – 2400 and 0000 – 0700 hours) apply to all days of the year.

These rates and modifiers are subject to change. Always consult the Fee Navigator for the most updated information.

Billing Examples:

In each of these examples, the physician is on-site for 2.5 hours and evaluates three patients during that time. In this scenario, a maximum of 10 units can be billed (2.5 hr ÷ 0.25 hr/unit = 10 units) across these three patients. If the patients were not seen for roughly equal amounts of time, distribute these units accordingly.

Disclaimer: The following examples are based on 03.01AA details at the time of publication, which are subject to change. Always consult the Fee Navigator for the most updated rules and rates.

Example 1: The entire shift occurred during the same modifier time blocks, so only one modifier is used for all 03.01AA claims.

Example 2: The shift spanned two different modifier time blocks, so different modifiers need to be used for 03.01AA claims.

Example 3: The shift spanned two different modifier time blocks, and two different dates. Different modifiers need to be used for 03.01AA claims.

Options for Internal Distribution of 03.01AA Funds

Clinical ARP groups will receive monthly Statements of Assessment, which will show the 03.01AA payments attributed to each physician as per the claims assessed. The 03.01AA earnings will vary by physician based on shifts worked and time spent on site providing eligible services.  The group may wish to distribute these funds to each physician as earned based on their individual claims, or, if there is variability in 03.01AA funding for similar length after-hours shifts, your program could decide to pay an average 03.01AA amount for each after-hours shift.  

The following are some examples of methods of distributing 03.01AA funds, but it is ultimately up to each ARP group to decide on their preferred distribution method:        

1. All participating physicians receive the same hourly rate for daytime hours worked, and those who provide after-hours services receive a time-premium payment for their individual eligible on-site hours claimed.
2. Participating physicians who work daytime hours receive the same base rate for hours worked. All participating physicians who work after hours (evenings and weekends) receive a higher base rate for their hours worked, by dividing the total 03.01AA payments equally across their pay.     
3. Divide the additional 03.01AA payments equally across all participating physicians, for a higher hourly base rate for everyone regardless of after-hours work.

It is important to note that no matter which internal distribution method you choose, total internal payments cannot exceed total ARP funding received (cARP FTE payments + 03.01AA after-hours time premium payments).