Out-of-Office Hours Premiums and
Emergency
Visits Introduction

 

The examples used in the Emergency Visits and Out-of-Office Hours Premiums modules of MSP Tutor have been simplified for clarity, and use visit fees from the Section of General Practice. Appropriate specialist visit fees or consultation fees should be used when submitting claims for services by a referred specialist.

General Billing Tips

The Claims Processing System has automated the processing of many claims. The following tips on billing formats will help to ensure that your claims are processed correctly, and in a timely manner.

Note Records

  • When MSP provides instructions to submit claims with a specific note record, use the exact format indicated. For example, the system can "read" and accept "CCFPP" but it cannot read "C C F PP". The system reads character "strings". Inserting additional spaces between letters in a word or abbreviation makes the note record unreadable by the system and can lead to refusals or payment delays.

Time Service Rendered

  • The time that the service was rendered should always be used as the "start time" for the claim. If the fee item requires a "time called" according to the Payment Schedule, this information should be provided in the note record.


  • The following fee items must have a "start time" in the "start time" field of your submissions to be accepted by the system:

    01200, 01201, 01202, 01210, 01211, 01212, 00112

  • The following fee items must have a "start time" and an "end time" in the appropriate fields of your submissions to be accepted by the system:

    01205, 01206, 01207, 01215, 01216, 01217

Overview of Fee Items for Emergency Visits and Out-of-Office Hours Premiums

Fee Item Description When to Bill
00112 Emergency Visit
(call placed between 0800 and 1800 hours) - weekdays
To be charged only when physician must immediately leave home, office, or hospital to render immediate care. Claim must state time service rendered.
01200 - 01202 Call-out Charges To be billed when the physician is specially called to render emergency or non-elective services and only when the physician must travel from one geographic location to another to attend the patient(s) during out-of-office hours. The call must originate in the designated timeframe and the service must be rendered in the designated timeframe. To be charged extra to the consultation or other visit, or extra to the procedure if no consultation or other visit charged. Claim must state time service rendered.
01205 - 01207 Non-operative
Continuing Care Surcharges
Applicable when an out-of-office hours call-out charge is applicable or when specially called for an emergency. Timing begins after the first 30 minutes for consultation, visits or anesthetic evaluations. Payment is based on one half-hour of care or major portion thereof. Claim must state start and end times.
01210 - 01212 Operative
Continuing Care Surcharges
Applicable only to emergency surgery or to elective surgery which, because of intervening emergency commences within the designated times. Applicable for the surgical assistant fees. Claim must state time surgery commenced.
01215 - 01217 Anesthesiology
Continuing Care Surcharges
Applicable when an out-of-office hours call-out charge is applicable or when specially called for an emergency. Timing begins after the first 30 minutes for consultations, visits, or anesthesiology evaluations. Payment is based on one half hour of care or major portion thereof. Claim must state start and end times.
01800 series Emergency Care To be billed when the physicians is designated as the emergency physician by the medical staff and is on hospital Emergency Department duty and on-site.

Disclaimer: MSP Tutor is intended to provide a guide for physicians and medical office assistants in billing claims to MSP. For definitive information on fee-for-service fee item codes and amounts, consult the current MSC Payment Schedule. If a discrepancy exists between the information contained in MSP Tutor and the MSC Payment Schedule, the information in the Payment Schedule will prevail.