Physician Billing Changes from the Alberta Government 2020

Earlier this year, the Alberta government released 14 Alberta Health Care Insurance Plan (AHCIP) bulletins. These bulletins announced significant changes to the Schedule of Medical Benefits and other support programs for physicians that will impact the compensation physicians receive. Almost immediately, the world was hit with the COVID-19 pandemic and the focus shifted. Then the government announced that some of the changes would be rescinded, alter some of the changes, and delay others. So where do this stand now?

In this post, we’ll detail the changes that have been made and which ones have been rescinded. You can also check out our table of AHCIP bulletins for an overview all changes announced to date. All changes announced are effective March 31, 2020 unless noted otherwise.

1) The Medical Liability Reimbursement Program is changing

Alberta Health has taken the responsibility for administering the Medical Liability Reimbursement (MLR) Program from the AMA. In doing so, the province is changing the deductibles for CMPA insurance fees. The new deductibles are shown in the table below. Urban physicians will pay varying deductibles according to specialty, ranging from $1,000 to $4,000. Rural physicians of any specialty will pay a $1000 deductible. The government had previously announced limited reimbursements and much higher deductibles for certain specialties (+$40,000 for obstetrics!) , but these deductible amounts were changed with the release of bulletin MED 232 on July 6, 2020.

Eligible physicians will need to apply for reimbursement through the MLR program. All applications must be submitted by December 31 to receive reimbursement for the current year. Payment of CMPA fees and reimbursement may be annual or quarterly. For annually payment physicians in the early reimbursement program, CMPA will delay its withdrawal of fees until August 1. Reimbursements are made directly to the physician’s bank account.

Relevant bulletins related to this changes: MED 218, MED 227, MED 232.

The application form and email for submission can be found here:

Table of Deductibles

Type of Work Codes Description CMPA Fee Physician Deductible Government Rebate
56 Neurology $13,248 $4,000 $9,248
77 Otolaryngology (head and neck surgery ) $13,248 $4,000 $9,248
83 General surgery $13,248 $4,000 $9,248
84 Gynecologic surgery $13,248 $4,000 $9,248
85 Pediatric surgery $13,248 $4,000 $9,248
86 Plastic surgery $13,248 $4,000 $9,248
87 Thoracic surgery $13,248 $4,000 $9,248
88 Urology $13,248 $4,000 $9,248
89 Vascular surgery $13,248 $4,000 $9,248
91 Cardiac surgery $13,248 $4,000 $9,248
92 Neurosurgery $25,704 $4,000 $21,704
93 Obstetrics $47,352 $4,000 $43,352
94 Orthopedic surgery $25,704 $4,000 $21,704
21 Pathology — Anatomical or General $5,016 $2,500 $2,516
38 Pain medicine $5,016 $2,500 $2,516
39 Obstetrics/Gynecology $5,016 $2,500 $2,516
45 Diagnostic radiology $5,016 $2,500 $2,516
47 Gastroenterology $5,016 $2,500 $2,516
50 Hematology $5,016 $2,500 $2,516
53 Critical/Intensive care medicine $5,016 $2,500 $2,516
54 Internal medicine and its subspecialties — notelsewhere noted $5,016 $2,500 $2,516
60 Ophthalmology $8,172 $2,500 $5,672
61 Pediatrics $8,172 $2,500 $5,672
66 Neonatal-perinatal medicine $5,016 $2,500 $2,516
70 Cardiology $5,016 $2,500 $2,516
82 Emergency medicine $8,172 $2,500 $5,672
90 Anesthesiology $8,172 $2,500 $5,672
31 Clinical associates and hospitalists on a medicalor surgical service $3,420 $1,800 $1,620
36 Psychiatry and addiction medicine $3,420 $1,800 $1,620
37 Surgical consultations/Office surgical practice $3,420 $1,800 $1,620
42 Clinical Immunology and Allergy $3,420 $1,800 $1,620
44 Dermatology $3,420 $1,800 $1,620
55 Nephrology $3,420 $1,800 $1,620
59 Oncology — Medical $3,420 $1,800 $1,620
62 Respirology $3,420 $1,800 $1,620
63 Rheumatology $3,420 $1,800 $1,620
64 Sport medicine $3,420 $1,800 $1,620
65 Oncology — Radiation $3,420 $1,800 $1,620
14 Residents and Fellows — Withmoonlighting/restricted registration —Includes out-of-province electives $2,040 $1,200 $840
20 Administrative medicine — Medicalexecutive/advisor/expert $2,040 $1,200 $840
23 Pathology — Hematological $2,040 $1,200 $840
24 Biochemistry — Medical $2,040 $1,200 $840
25 Microbiology — Medical $2,040 $1,200 $840
26 Pathology — Neuropathology $2,040 $1,200 $840
27 Physical medicine and rehabilitation $2,040 $1,200 $840
28 Public Health and Preventative Medicine (Community medicine) $2,040 $1,200 $840
33 Assistance at surgery $2,040 $1,200 $840
46 Endocrinology and metabolism $2,040 $1,200 $840
48 Genetics — Medical $2,040 $1,200 $840
51 Occupational medicine $2,040 $1,200 $840
52 Infectious diseases $2,040 $1,200 $840
58 Nuclear medicine $2,040 $1,200 $840
35 Family medicine or General practice —Excluding anesthesia, obstetrics (labour anddelivery), shifts in the emergency department, and surgery $3,420 $1,000 $2,420
73 Family medicine or General practice —Primary professional work in family medicine including shifts in the emergency department $3,420 $1,000 $2,420
78 Family medicine or General practice — Including obstetrics (labour and delivery), anesthesia, surgery, and shifts in the emergency department $8,172 $1,000 $7,172
79 Family medicine or General practice —Including anesthesia, surgery and shifts in the emergency department $8,172 $1,000 $7,172
Any Rural physicians Depends on type of work $1,000 Remainder of fee depending on type of work

2) Continuing Medical Education Program is ending

The government is ending funding to the AMA for the Continuing Medical Education Program. The AMA will need to end or self fund the $2,684 previously provided to physicians for costs incurred with regard to the maintenance and enhancement of knowledge, skills and competency. Relevant Bulletin MED 219.

3) Facility based HSCs are changing for publicly funded facilities

Physicians will receive lower compensation for overhead when a service is provided in a registered publicly funded facility. These new codes will likely be of lower value. For example, code 03.03A ($25.09) will be replaced by new lower value code 03.03AZ ($18.50).

Effective March 31, 2020, physicians are to use the new “z-codes” for services provided in a publicly funded facility. However, “z-codes” will pay at the higher in-office rate for all physicians until implementation of the lower rates on October 1, 2020. There is an exception for rural physicians. Rural physicians will be able to use billing codes that have overhead included and they will be exempted from any future changes to the policy. Below is a table of new out-of-office HSCs and the corresponding in-office HSCs. Relevant bulletins: MED 215, MED 223, MED 227.

Current HSCs (in-office, for services performed in self-funded facilities e.g. community clinics, registered rented offices in an AHS facility) New HSCs (out-of-office, for services performed in publicly funded facilities (e.g. hospitals)
03.03A 03.03AZ
03.03B 03.03BZ
03.03F 03.03FZ
03.04A 03.04AZ
03.05I 03.05IZ
03.07A 03.07AZ
03.08A 03.08AZ
03.08B 03.08BZ
03.08I 03.08IZ
03.08J 03.08JZ
08.19A 08.19AZ
08.19G 08.19GZ
08.19GA 08.19GZ
08.45 08.45Z

4) A daily patient visit cap has been implemented

The government added a daily patient volume payment rules that applies to all visit services with a “V” category code that are provided in a physician office. Physicians are paid 100% of code values up to 50 patients per day, 50% of code values for the 51-65 patients seen, and no compensation for 65 or greater. The cap does not apply to rural areas. The cap does apply to non-rural areas, defined as: Edmonton, Sherwood Park, St. Albert, Devon, Stony Plain, Leduc, Fort McMurray, Grand Prairie, Airdrie, Red Deer, Calgary, Medicine Hat, and Lethbridge. The government updated this announcement to exclude Health Service Code 13.82A from the cap (Psoralen ultraviolet A treatment, ultraviolet B or narrow-band ultraviolet B treatment). Relevant bulletins: MED 214, MED 220.

5) The Good Faith claim program has ended

The Good faith claim program ended on March 31,2020. Alberta health will no longer pay for claims submitted in good faith for patients without a valid Alberta Personal Health Number (PHN). The patient can be billed privately. However, if the patient subsequently provides an Alberta PHN within 90 days of the date of service, the private billing amount must be reimbursed to the patient and a claim submitted to Alberta Health. Relevant bulletin: MED 122.

6) Time limit for claim submission has changed

The Alberta government has changed the time limit for practitioners to submit claims to the Alberta Health Care Insurance Plan (AHCIP) from 180 days to 90 days. This change applies to both new claims (90 days after the date on which the health service was provided or the patient was discharged from the hospital) and resubmitted claims (90 days after the date on the last Alberta Health Statement of Assessment on which the claim appeared). Relevant bulletin: GEN 123.

7) There are changes impacting specific physician groups

Family Physicians

The Alberta Government has made changes to the Schedule of Medical Benefits to de-insure Development of a Comprehensive Annual Care Plan and the driver’s medical examination for Patients 74.5 Years of Age or Older. Relevant bulletins: MED 210, MED 211.


Diagnostic Imaging (DI) services that are referred by a chiropractor, physiotherapist, or audiologist de-insured from Schedule of Medical Benefits. Health Service Codes X301, X303, X311, X315, X316, X317, X318, and X319 have been amended to provide the correct interpretation of the services submitted in accordance with the Schedule of Medical Benefits. Relevant bulletins: MED 212, MED 213.

Rural Physicians

Business Cost Program (BCP) payments will be made at the rate of one BCP base payment per eligible claim. BCP payments for subsequent calls and modifiers associated with claims will be discontinued.
All other program parameters will remain the same. These changes are to be effective March 31, 2021. Relevant bulletin: MED 216.

Rescinded/Amended Bulletins

Medical Liability Reimbursement Program

The government had announced limited reimbursements for CMPA insurance fees. This would have resulted in very high deductibles for some specialties, some over $40,000. This announcement was amended with MED 232 released July 6, 2020. The maximum deductible is now $4000. Relevant bulletins: MED 218, MED 227, MED 232.

Complex Patient Modifiers

The government had announced increased time thresholds for complex modifier codes. This bulletin were rescinded March 17, 2020. Relevant bulletin: MED 209.

Changes to Rural Remote Northern Program

The government had announced changes to the Rural Remote Northern Program (RRNP), eliminating Flat Fee payments and reassessing the Variable Fee Premiums payment component. This bulletin was rescinded April 27, 2020. Relevant bulletin: MED 227.

And that’s the current list of changes! We expect more changes to be announced and we will continue to keep you updated. Check out our table of AHCIP bulletins for an overview all changes announced to date. The Alberta government has also detailed a summary and rationale for the changes which might be of interest. If you have any questions questions regarding these changes or the impact to your billing, please get in touch – we’re happy to chat.