On February 1, 2023, the Ministry introduced the new Longitudinal Family Physician (LFP) Payment Model for family doctors to help protect, support, and strengthen British Columbia’s health care system and patient care.
Since the LFP payment model came into effect, more than 2,000 physicians have enrolled into the program, representing about 45% of longitudinal family doctors. Learning a new payment model can be overwhelming and could potentially take away from time taking care of your patients.
To help doctors better understand the impact and opportunities of the new LFP payment model, we have compiled a list of the most frequently asked questions we have received from our doctors.
Billing & Payment
Can I bill an interaction code when my nurse practitioner performs an injection for a patient?
Nothing needs to be billed on behalf of the nurse practitioner, the physician can bill indirect care as they are providing supervision.
Is there any restriction on billing indirect time (reviewing labs, research) on the weekend?
There are no restrictions on the weekends. However, the maximum amount of time payable is 120 hours every two weeks. If physicians don’t go over that amount, they can bill for any of the time codes whether it be indirect, direct, or administrative.
I start my day reviewing results. Do I bill that under the patient whose first result I reviewed and document the start and end time for that patient?
If you are seeing or phoning patients in between reviewing results, you would bill 98010 under the first patient of the day. You will also need to document the start and end times as well as the number of units.
If you are only reviewing results, then you would bill 98011 under the first patient you reviewed results for and include start and end times with the number of units.
Venereal warts are listed as an advanced procedure, but a cryotherapy is listed as a minor procedure. Should I be billing under advanced or minor procedure?
Venereal warts are included under the interaction code 98020. All other cryotherapy is under interaction code 98022.
I spoke with a patient on the phone about their lab results, can I bill for the 98032 or do I bill for .5 units?
You can bill the 98032 fee code but would not be able to bill .5 units. Alternatively, you can just include this call in your 98010 time code billing.
If a doctor has a call with another doctor, what should they bill that time under?
They would bill this time under indirect patient care.
If physicians don’t have a starting panel of 250 patients, can they still enroll into the LFP?
You will need a panel of 250 active patients from the time you enroll into the new payment model NOT after you have already signed up.
However, if you are a new physician, you do not need a panel of patients but must have grown your panel to 250 patients after 4 months of enrolment.
Can you opt into the LFP model at multiple clinics?
No – you must enroll into the LFP payment model with a specific clinic.
I need to submit a few claims from before I enrolled into the LFP payment model. Is it still possible for me to submit them under the traditional MSP model?
Yes, you can submit any fee for service claims that took place before the date you registered for the new LFP payment model.
Will I continue to receive CLFP payment if I move to the LFP payment model?
The Community Longitudinal Family Physician (CLFP) Payment is an FPSC payment that is primarily intended to provide financial support to fee-for-service family physicians who maintain relational continuity with a panel of patients. As a result, it will not be paid to physicians who move from fee-for-service to the LFP payment model.
Instead, physicians being paid under the LFP payment model will receive a panel payment based on your number of active patients and the complexity of those patients.
Can I bill an additional visit when I see patients for other conditions unrelated to an ICBC visit?
Services like ICBC, RoadSafetyBC, and WorkSafeBC cannot be billed under the LFP Payment model. These visits need to be billed under fee-for-service.
However, if you see the patient for a different condition in the same visit, you can bill an interaction code 98031. You would need to ensure the diagnostic (Dx) code is different from the fee for service claim.
Note: even if you are eligible for the 98031, you cannot bill the time codes for this service.
My practice provides more than 30% of non-panel services. Can I still enroll into the LFP payment model?
To enroll in the LFP payment model, physicians must not exceed the 30% limit on non-panel services.
However, the Ministry has reached an agreement to create a temporary exemption for this limit. If you are currently working on transitioning your practice to meet this 30% limit, you can submit the Transition Code (98001) after the Registration Code to access an exemption until March 31, 2024.
If you would like to learn more about how to submit the transition code, visit the updated LFP payment schedule here.
Do locums need to enroll under the new LFP payment model?
Yes. Locum registration for billing under the new payment model will be available by March 13. If the physician is providing long term coverage (ex. parental leave), it is recommended that the locum and host physicians discuss adjusting compensation to recognize the longer-term commitment to the patient panel.
Can locums bill indirect and administration codes?
Locums have their own specific time and interaction codes that they can bill under the LFP payment model. You can find the codes in the LFP Payment Model Schedule here.
How is the patient/panel complexity be calculated?
For 2023, patient complexity will be calculated using the Community Longitudinal Family Physician (CLFP) methodology. However, a new calculation for panel patients is currently in progress. You can read more about how to utilize the CLFP method here.
Note: we recommend using all three Dx spots if applicable to help capture and monitor complexity.
If I see a patient virtually but then need to see them in person on the same day, can I bill for both visits?
Here is what you need to know if you have multiple visits by the same patient in one day:
- You can bill direct patient care.
- You cannot bill a second patient interaction code unless the second visit is for
- A new condition; or
- The condition has worsened significantly and requires a new assessment.
- To bill more than one patient interaction code for the same patient on the same calendar day:
- Provide the time for each interaction in the time for each patient interaction code;
- Provide a note record indicating the reason for the second interaction; and
- Use submission code “D” for the second patient interaction code.
What percentage can a doctor work from home under the new LFP payment model?
There are currently no regulations on the ratio of working from home vs. in person. However, you must ensure that you don’t exceed 120 hours in a two-week period. The 120 hours can be any combination of direct care, indirect care, and clinical administration.
What does out-of-province patient mean?
An out of province patient refers to patients with a PHN from a different province. The patients will be billed under fee-for-service.
To help you better understand and navigate the LFP payment model, we have created additional resources including:
- On-Demand Webinar: A Guide to the Longitudinal Family Physician Model
- Quick Reference Guide: LFP Payment Model
Are you unsure as to whether the LFP payment model is for you? Contact us today and we can conduct an analysis of your practice to help you determine the best path forward.