How is the panel/roster size calculated?

When calculating physician panels, the DHW considers the New Patient Intake Visit (NPIV1) code and the ME=CARE modifier.

• Use of the NPIV1 code will immediately roster a patient to your panel.
• In the absence of a NPIV1 code, use of the ME=CARE service modifier will be used to determine rostering. The DHW considers:
  • the number of ME=CARE encounters with each provider
  • most recent ME=CARE encounter date with each provider, with more recent visits weighted more heavily 

In the absence of a billed NIPV1 code, the patient is counted in the panel of the physician with whom they have had the most ME=CARE encounters. If tied, the patient is counted in the panel of the physician with whom they have had the most recent ME=CARE encounter.

Panel size is calculated dynamically and smoothed for payment every quarter.

Your panel payment

You will receive $103 per year for each patient rostered to your panel. (The panel payment will increase by 3% on April 1, 2024.) Panel payments are smoothed into your biweekly paycheque. Bill the NPIV1 code when accepting a new patient into your practice, including for newborn babies.

How are my “healthy unseen” patients counted?

The DHW understands that physicians have a number of “healthy and unseen” patients in their practice. To account for this, an additional 10% is added to your calculated panel size. Currently, if a patient has been added to your panel by billing NPIV1, they will only be removed from your panel when another physician bills NPIV1 for that patient. If a patient has been added to your panel based on the ME=CARE algorithm, they will be removed from your panel if another physician bills ME=CARE for that patient more often than you or if a physician claims the NPIV1 code for that patient. Nurse practitioners do not shadow bill ME=CARE, so seeing a nurse practitioner will not result in a patient being removed from your panel.ME=CARE is also not billable by walk-in clinics, local emergency departments or
primary care access clinics (PCCs). Accessing services in these locations will also not result in a patient being removed from your panel.

Note: The LFM attachment methodology is evolving and being refined on an ongoing basis. Changes will be made with approval of all stakeholders and members will be notified accordingly. The above information is true as of the date of publication.

What is ME=CARE? 

ME=CARE is a fee code modifier established in 2019. Physicians receive a premium on most office-based billing codes when seeing a rostered/attached patient. Physicians must commit to providing ongoing comprehensive primary health care to that attached patient to claim ME=CARE. ME=CARE can be billed for a patient of another provider within your collaborative practice group.

What about patients who receive prenatal care outside of my practice?

Prenatal care codes are not accounted for in the ME=CARE attachment algorithm, so the patient will remain on your panel.

Community complexity modifier 

The LFM payment model includes a community complexity modifier to account for variations in socio-economic status factors in different communities. This calculation is currently based on your community of  practice, but work is being done to provide a more accurate calculation that would reflect the actual medical complexity of your specific patient panel. This is still under development. Currently, the complexity modifier is applied automatically to your panel and hourly payments and smoothed into your biweekly payments. The community complexity modifier is paid as a quarterly premium on your 30% FFS claims.

How to request a panel validation

Physicians may participate in a panel validation exercise to receive a report comparing their panel size as calculated by their EMR patient count and the panel size as calculated by the ME=CARE/NPIV1 algorithm. Email psaccountability@novascotia.ca to request a panel validation.

Physicians are responsible for all claims

You are responsible even when claims are entered by someone else, such as billing staff. MSI is the ultimate authority on physician billing. If you have questions about billing under the LFM, email MSI and save the response for audit purposes.

More tips for billing success

• Bill submitted (actual) hours worked, including paperwork time, but keep an eye on your service encounter ratio. Make sure to distinguish between daytime (non-premium) (HDAY1) hours and premium (HEVW1) hours.
• Billing hours daily (or when you bill your FFS billings) is best practice. Do not delay billing your submitted (actual) hours worked. Use calendar reminders to make sure you don’t forget and consider using an app to help track your submitted (actual) hours worked.
• Consider using your EMR to help you log times. In Med Access, use the “Memo” feature at the top of your daily schedule to log your start/end times for every work session.
• Remember that EMR data can be easily accessed to see every click you make and when you made it. This information can help you track your submitted (actual) LFM hours if needed. Refer to your cell phone call log for phone call durations.
• Get in the habit of time-stamping all encounters – for example, if you realize you had a patient encounter that will be billed to Veteran’s Affairs or WCB NS, you’ll need to subtract it from your actual hours worked. Find the times by checking the time stamps on the visits straddling that encounter. When the visits on either side of it were time-stamped, the calculation is easy to do.