Virtual Care Code Changes – Recognition of Patient Management Time

To support the appropriate uptake and integration of virtual care in the province, patient management that is related to the provision of an insured service may be included in the time calculations for certain virtual services. This means the physician time spent reviewing patient charts, completing referrals, etc. may count toward the time requirements for Health Service Codes (HSC) 03.01AD, 03.03CV, 03.03FV, and 03.08CV. To be eligible to claim for patient management time, all services must be completed by the physician on the same date as the patient’s virtual visit. Virtual visits still require that the physician have direct contact with the patient, the patient’s guardian or agent (as defined by the Personal Directive Act). Only physician time can be claimed.

Claims for virtual care with the appropriate modifier may be submitted after AH has notified physicians through an updated Bulletin. If holding back claims for these services is not an option for you, please read the claims submission information at the end of this Billing Tip.

Claim Submission Information

Alberta Health has not announced the go-live date for submission of virtual care claims with a modifier.

In the meantime, physicians may either; 1) hold their claims for these services or 2) submit a claim for the virtual visit without modifier and change (Action Code C) the claim to include the modifier when the Alberta Health system is ready to accept virtual claims with a modifier. Option 2 requires more administrative attention but offers the option to receive some compensation in a shorter time frame. Here are the steps for option 2:

1. Submit the claim to Alberta Health without the modifier
2. Following Alberta Health’s advice that claims for virtual codes with modifiers may be submitted: 
   • retrieve the original claim (assuming the claim paid as submitted without any explanatory codes on the Statement of Assessment from AH);
   • add the appropriate modifier to the claim;
   • resubmit the claim using action code “C”;
   • You should receive payment for the modifier portion of the claim only on the next Statement of Assessment from Alberta Health.

Reminders:

• DO NOT add text to the claim, 
• Be sure to use action code “C” as it signals that there is a change to the claim. The payment system will then process ONLY the changes. The next statement of assessment from AH will include a payment for the modifier portion of the claim only.
• DO NOT generate a new claim number; be sure that you are using the original valid claim number. If you use a new claim number or generate a new claim, AH’s payment system will deem the second claim to be a duplicate claim and the claim will reject.

For more information about claims submission processes, please refer to section 3.0 Claims Submission of the Physicians Resource Guide.

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