Table of AHCIP Bulletins Impacting Physician Billing
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 Then the government announced that some of the changes would be rescinded, alter some of the changes, and delay others. To help you keep track of what was announced, what is changing and what announced changes were rescinded or amended, we have collected a table summary below.
| Bulletin | Link | Summary | Applicable to | Updates | Effective Date |
|---|---|---|---|---|---|
| MED 209 - Complex Patient Modifiers | https://www.alberta.ca/assets/documents/health-med-209-bulletin-complex-modifiers.pdf | Time thresholds for complex modifiers for consultations and visits increased | All physicians | RESCINDED | March 31, 2020 |
| MED 210 - Comprehensive Annual Care Plan | https://www.alberta.ca/assets/documents/health-med-210-bulletin-comprehensive-annual-care-plan.pdf | Development of a Comprehensive Annual Care Plan de-listed from the Schedule of Medical Benefits | Family Physicians | STILL IN PLACE | March 31, 2020 |
| MED 211 - Driver medical exam for patients 74.5 years of age or older | https://www.alberta.ca/assets/documents/health-med-211-bulletin-driver-medical-exam.pdf | Driver’s Medical Examination for Patients 74.5 Years of Age or Older de-insured from the Schedule of Medical Benefits | Family Physicians | STILL IN PLACE | March 31, 2020 |
| MED 212 - Payment for Diagnostic Imaging Referred by Chiropractors, Physiotherapists, and Audiologists | https://www.alberta.ca/assets/documents/health-med-211-bulletin-driver-medical-exam.pdf | Diagnostic Imaging (DI) services that are referred by a chiropractor, physiotherapist, or audiologist de-insured from Schedule of Medical Benefits | Radiologists | STILL IN PLACE | March 31, 2020 |
| MED 213 - Diagnostic Imaging Billing Appropriateness | https://www.alberta.ca/assets/documents/health-med-213-bulletin-diagnostic-imaging-billing.pdf | Health Service Codes X301, X303, X311, X315, X316, X317, X318, and X319 will be amended to provide the correct interpretation of the services submitted in accordance with the Schedule of Medical Benefits | Radiologists | STILL IN PLACE | March 31, 2020 |
| MED 214 - Daily Patient Visit Cap | https://www.alberta.ca/assets/documents/health-med-214-bulletin-daily-patient-visit-cap.pdf | Daily patient volume payment rules will apply to all visit services with a “V” category code that are provided in a physician office. | All physicians | UPDATED WITH MED 220 | March 31, 2020 |
| MED 220 - Daily Patient Visit Cap Amendment | https://open.alberta.ca/dataset/58a224a2-0fed-4b1e-b8d5-9f6cf70450c6/resource/a8d72ad8-89e3-45e4-9cba-893ab418c5da/download/health-ahcip-bulletin-med-220.pdf | The daily patient volume payment rules will apply to all visit services with a “V” category code that are provided in a physician office, with the exception of health service code (HSC) 13.82A (Psoralen ultraviolet A treatment, ultraviolet B or narrow-band ultraviolet B treatment) | All physicians | STILL IN PLACE | March 31, 2020 |
| MED 215 - New Facility Based Health Service Codes | https://www.alberta.ca/assets/documents/health-med-215-bulletin-facility-based-codes.pdf | Physicians will no longer be able to receive compensation for overhead when a service is provided in a registered publically funded facility | All physicians | UPDATED WITH MED 223, MED 227 | March 31, 2020 |
| Med 223: Rates for New Facility Based Health Service Codes | https://www.alberta.ca/assets/documents/health-ahcip-bulletin-med-223.pdf | Details specific lower value codes for certain services provided in a registered publically funded facility | All physicians | UPDATED WITH MED 227 | March 31, 2020 |
| AMENDED Med 227: Changes to the Schedule of Medical Benefits, Rural Remote Northern Program, and Medical Liability Reimbursement | https://open.alberta.ca/dataset/58a224a2-0fed-4b1e-b8d5-9f6cf70450c6/resource/e5222b53-7bf4-46e6-88f1-fe23d1787f66/download/health-ahcip-bulletin-med-227-changes-medical-benefits-rrnp-medical-liability-reimbursement.pdf | MED 223 is delayed until October 1, 2020. Effective immediately, 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.Rollback of changes to Rural Remote Northern Program. (MED 217)Alberta government assuming responsibility for administering the Medical Liability Reimbursement Program. Details on physician deductibles and government rebates on CMPA fees (MED 218) | All physicians | STILL IN PLACE | Oct 1, 2020 |
| MED 216 - Business Costs Program | https://www.alberta.ca/assets/documents/health-med-216-bulletin-business-costs-program.pdf | There are no changes until March 31, 2021.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. | Rural Physicians | STILL IN PLACE | March 31, 2021 |
| MED 217 - Rural Remote Northern Program | https://www.alberta.ca/assets/documents/health-med-217-bulletin-rural-remote-northern-program.pdf | Under the Rural Remote Northern Program (RRNP), Flat Fee (FF) payments will be eliminated. Variable Fee Premium (VFP) payment component will be maintained, but will be assessed | Rural Physicians | RESCINDED | March 31, 2021 |
| MED 218 - Medical Liability Reimbursement Program | https://www.alberta.ca/assets/documents/health-med-218-bulletin-medical-liability-reimbursement.pdf | Government will make changes to provide fixed funding amount to AMA for Medical Liability Programs. Those changes were confirmed in MED 227. | All physicians | STILL IN PLACE | April 24, 2020 |
| MED 232 - Medical Liability Reimbursement Application Process | https://open.alberta.ca/dataset/58a224a2-0fed-4b1e-b8d5-9f6cf70450c6/resource/f855887e-e39b-4998-a027-982580ec3fc9/download/health-ahcip-bulletin-med-232-medical-liability-reimbursement-application-process.pdf | Revised deductibles accounced in MED 227. Deductible range $1000 - $4000 for urban physicians and $1000 for rural physicians. | All physicians | STILL IN PLACE | April 24, 2020 |
| MED 219 - Continuing Medical Education Program | https://www.alberta.ca/assets/documents/health-med-218-bulletin-medical-liability-reimbursement.pdf | 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 | All physicians | STILL IN PLACE | march 31, 2020 |
| GEN 122: Good Faith Claims Payment Policy Update | https://www.alberta.ca/assets/documents/health-gen-122-bulletin-good-faith-claims-policy.pdf | Good faith claims will no longer be paid | All physicians | STILL IN PLACE | march 31, 2020 |
| GEN 123 - Change to claim submission time limit | https://www.alberta.ca/assets/documents/health-gen-123-bulletin-claim-submission-time-limit%20.pdf | Good faith claims are ending. Alberta health will no longer pay for claims submitted in good faith for patients without an Alberta Personal Health Number (PHN). | All physicians | STILL IN PLACE | march 31, 2020 |