Long-term care facility visits (fee items 00114 and 00115)

Issue: BCMJ, vol. 58 , No. 7 , September 2016 , Pages 401 Billing Tips

The roll-out of the GPSC Residential Care Initiative represents a major advance in delivering high-quality care to residential care residents in British Columbia. One of the expectations of the initiative is the provision of proactive visits. However, recent audits have identified some issues with the following long-term care fee items (00114 and 00115).

Common errors seen in audits

Fee item 00114 (one or multiple patients, per patient):

  • Claims exceeding the maximum of one visit every 2 weeks. If the visits are beyond the limit of one every 2 weeks, a note stating the medical necessity is required.
  • Billing out-of-office visits (not appropriate for day visits,* after hours only).
  • Physician reviewing the chart and not seeing the patient. A face-to-face patient-doctor encounter must be made.

*The Preamble to the General Practice section of the Doctors of BC Guide to Fees states that out-of-office visit fees are applicable unless the circumstance of the service is specifically covered by the definition of fee item 00103, 00108, 13008, 00109, 00127, 00128, 13028, 00111, 00112, 00114, 00115, 00113, 00105, 00123, 13228, or one of the 01800 series.

Fee item 00115 (nursing home visit—one patient, when specially called):

  • Visits appear to be on a set day or the physician’s regular round day. The visit must take place within 24 hours of receiving the request from the nursing home.
  • No evidence the physician was specially called. Documentation should include who called, the time called, and the medical necessity.

Refer to Preamble D.4.9. Long-Term-Care Institution Visits for more information.
—Keith J. White, MD
Chair, Patterns of Practice Committee

hidden


This article is the opinion of the Patterns of Practice Committee and has not been peer reviewed by the BCMJ Editorial Board. For further information contact Juanita Grant, audit and billing advisor, Physician and External Affairs, at 604 638-2829 or jgrant@doctorsofbc.ca.

Keith J. White, MD. Long-term care facility visits (fee items 00114 and 00115). BCMJ, Vol. 58, No. 7, September, 2016, Page(s) 401 - Billing Tips.



Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
  • There is no period after the journal name.
  • Page numbers are not abbreviated.


For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org

BCMJ Guidelines for Authors

Leave a Reply