Manitoba Health: Extended Hours Premium for Primary Care  

Effective February 1, 2023, Manitoba Health introduced a premium for family medicine and pediatric clinics offering extended hours. This premium helps increase access to primary care providers and pediatricians while alleviating some pressure on overwhelmed hospitals.

In this blog, we share the details around the new extended hours premium and how physicians can take advantage of this new opportunity.

Overview of the Extended Hours Premium  

Physicians will receive a 20% premium for all visits offered during the extended hour period. Participation is optional; extended access can be offered to your existing patients and/or walk-in appointments.

Two premiums can be billed for extended hours:

Tariffs Description Rate
5530 Extended clinic hours premium 6:00AM-8:00AM or 5:00PM-11:59PM on weekdays 20% to payable fee
5531 Extended clinic hours premium 7:01AM-11:59PM on Saturday, Sunday, and design holidays 20% to payable fee

Note: Recognized Holidays include New Year’s Day, Louis Riel Day, Good Friday, Easter Monday, Victoria Day, Canada Day, Terry Fox Day, Labour Day, National Day for Truth and Reconciliation, Thanksgiving Day, Remembrance Day, Christmas Day, Boxing Day.

Eligibility Requirements

 To be eligible for the extended hours premium, physicians must satisfy the following two requirements:

1. Clinic Hours

The clinic must be open for a minimum of eight hours, from Monday to Friday, between standard operating hours of 8:00am and 5:00pm. For example, 8:00am-4:00pm, or 8:30-4:30pm, or 9:00am-5:00pm.

Clinics cannot shift their existing hours into extended hours periods. An extended clinic hours premium may not be claimed for a patient scheduled to be seen before the extended hours period.

2. Advertising

The extended clinic hours must be advertised to the public or the clinic’s own patients and the patient has the option for in-person availability.

Examples of advertising for existing patients include posters in office, information on website, or a mass email message.

Examples of advertising for walk-in access include promoting availability through Medimap.

Billing Requirements & Exclusions

Once a physician has determined that they are eligible to bill for this tariff, they must keep in mind the following billing requirements:

  1. The hours apply to the clinic and its physicians collectively, not individually. Physicians who work part-time hours can participate in extended hours.
  2. The time the service commences must be entered on the claim.
  3. NT1 or NT2 may not be claimed with Tariffs 5555, 5553, 5550, 5556, 5557 and 5558.
  4. Tariffs 8000, 8001, 8002, 8003, 8005 and annual management tariffs such as but not limited to CDM and CCM tariffs, are not eligible for the extended clinic hours premium.

Need Assistance? We Can Help!

DoctorCare helps doctors sort through confusing billing rules, automate billing submissions, ensure errors are fixed, and optimize billings to maximize revenue. If you are interested in learning more about how we can help, contact us to set up a free consultation.

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