After-hours work over 2016 stat holidays

G.R. 1.2 "holidays" or "statutory holidays" means New Year's Day, Family Day, Good Friday, Victoria Day, Canada Day, Alberta Heritage Day, Labor Day, Thanksgiving Day, Remembrance Day, Christmas Day, Boxing Day;

The table below is designed to help clarify your holiday billings for 2016. Please note that after-hours time premium (03.01AA) and surcharge modifiers only apply to services that are provided in a regional facility i.e. hospital, auxiliary hospital, active treatment center, nursing home, AACC/UCC and not in a physician’s private office.

Callback codes for holidays

These callback codes are selected as they are relevant to statutory and designated holidays. For a complete list of callback codes please consult the Schedule of Medical Benefits. Reminder; the physician must be located outside of the facility property at the time of the call in order to claim a callback. These callbacks are also billed in addition to a visit code (03.02A, 03.03A, 03.03B, 03.04A, 03.03EA as appropriate)

Callbacks for hospital emergency/outpatient department, AACC, UCC, auxiliary hospital or nursing home should be submitted as:

• 03.03LA between 0700-2200 hours designated holidays and statutory holidays
• 03.03MC between 2200-2400 hours
• 03.03MD between 2400-0700 hours

Callbacks for hospital inpatients should be submitted as:

• 03.05R between 0700-2200 hours designated holidays and statutory holidays
• 03.05QA between 2200-2400 hours
• 03.05QB between 2400-0700 hours
• These callbacks are also billed in addition to a visit code (03.03DF)

Surcharge Information

The AMA would like to remind physicians that in order to claim for surcharges you must meet all of the following criteria:

• Special call for attendance.
• Respond to the call on an unscheduled basis outside of normal working hours.
• Patient is attended on a priority basis.
• There is direct attendance by the physician (see GR 15 for full details).

03.01AA Information

If a service crosses multiple time periods, use more than one modifier on the claim (e.g., service start time 2115 hours, end-time 2245 hours, the claim submitted would be: 03.01AA modifier one TEV03; modifier two TNTP03).

If a service crosses dates, split the claim for 03.01AA into two claims with two separate dates of service (e.g., start-time day one 2300 hours, end-time day two 0015 hours, the claim for 03.01AA would be: day one 03.01AA TNTP04; day two 03.01AA TNTA01).

Please do not forget that the total time premiums claimed cannot exceed the total time spent managing patient care and no more than four (4) units per hour.

If you spent a total of eight (8) hours providing patient care, you only have eight hours total of time premium (32 units total) that you can submit. You may not submit claims for more than four (4) time units per hour.

Many physicians are unaware that there are maximums for this health service code. The maximums allowable per day, per time period for the total time spent are as follows:

• 20 units – TEV (Monday – Friday 1700-2200)
• 8 units – TNTP (Any day 2200-midnight)
• 28 units – TNTA (Any day midnight-0700)
• 60 units – TWK (Weekend 0700-2200)
• 60 units – TST (Statutory holidays 0700-2200)
• 60 units – TDES (Designated holidays 0700-2200)

This means that if the total time spent managing patient care for 15 patients required three (3) hours of time, you could submit 12 units of 03.01AA. You may ONLY submit claims for 03.01AA for the total time spent managing patient care and not the total number of patients that were seen. You must have physically seen the patient on the same date in order to submit claims for 03.01AA.