How often have you been called to see a patient in hospital after a long shift, and thought: “If only there were some sign of appreciation…”
Well there is. Special visit premiums (SVPs) are designed for those times when physicians are called unexpectedly to care for patients and – beyond a few limitations – add a generous boost to a doctor’s income. Although most doctors are aware of SVPs for evening and night shifts, many still don’t know that unique weekend/holiday SVPs are available, and with Labour Day (and the end of the summer…) approaching quickly, we thought we’d discuss them.
How to apply SVPs to my billing
Special Visit Premiums can be confusing because of all the rules, restrictions, and limitations. In a future blog post, we will explore these in detail. For now, however, we’re going to define a special visit as a “visit initiated by a patient or an individual on behalf of the patient for the purpose of rendering a non-elective service”. This is from GP43 of the Schedule of Benefits. Any unexpected visit to a patient on a holiday or weekend is eligible for a SVP, except if the visit is part of hospital rounds or if the visit would be considered routine. Further, if the physician is following up on his or her own patient at his or her discretion, no special visit has taken place and no SVP would be payable.
The MOH has two different categories of SVPs for weekends and holidays – one for the first patient a physician sees at the destination, and one for any additional patients the physician sees on that same trip. The MOH also has a travel premium that’s payable on the first patient seen when the physician travels to the hospital from outside of hospital grounds. To complicate things further, the SVPs are different depending on where the patient is seen, for instance in the Emergency Department or on the Ward. See the chart below:
|Weekend and Holiday SVPs||Emergency Department Patients||Hospital In-Patients|
|Travel Premium||K963- $36.40||C963 – $36.40|
|First Patient Seen||K998 – $75.00||C986 – $75.00|
|Additional Patient Seen||K999 – $75.00||C987 – $75.00|
For weekends and holidays, SVPs have very generous maximums. Physicians are limited to a maximum of 20 SVPs per day and up to 6 travel premiums in the Emergency Department and the same maximums for SVPs and travel premiums on the ward. Remember too that if you see a patient between midnight and 7am on a weekend or holiday, the night time special visits and travel premiums should be billed as they are worth more.
Example of Special Visit Premium Billing on Labour Day
Dr. G, one of our Internal Medicine Specialists, is on-call at her hospital on Labour Day. At 8am, she gets called in to consult on a patient in the ED and travels from home. While there, Dr. G is asked to consult on two other ED patients and is then asked by staff to see two in-patients on the ward. After seeing these patients, Dr. G decides to round on two of her own patients that she’d been following all week as MRP. Here’s what she would bill:
|Patient 1||8am -called in from home to ED||A135/K998/K963|
|Patient 2||8:45am – still in ED||A135/K999|
|Patient 3||9:25am – still in ED||A135/K999|
|Patient 4||10:00am – requested by nurse to see admitted patient||A133/C986 (no travel!)|
|Patient 5||10:24am – requested by doctor to see admitted patient||A135/C987|
|Patient 6||10:55am – rounds on her own patient||C132/E083 (no SVP!)|
|Patient 7||11:10am – rounds on her own patient||C132/E083 (no SVP!)|
Note for Psychiatrists: When billing SVP’s, use A895 instead of A195. It’s not only the rule, it’s worth more!
Dr. G now catches a break and heads home. At 2:20pm, she’s called back to the ED for a couple of new consultations, and the process starts again with a new first patient seen premium (K998) and a new travel premium (K963). What if Dr. G forgot to add a SVP for a patient? No problem – we always keep a sharp eye out for that sort of thing and would have corrected her billing already.