Special Visit Premiums for ER and Inpatient Ward

We have previously blogged about special visit premiums, but there is always more to cover and it is good to have a reminder of how your special visit premium works. JCL Medical Systems, an OHIP billing company in the GTA has written the following blog on Special Visit Premiums for ER and Inpatient Ward. Make sure you pay close attention because JCL has great experience in OHIP billing and anything they share will be helpful to you!

Special Visit Premiums for ER and Inpatient Ward By JCL Medical Systems  

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 another long weekend approaching quickly, we thought we’d discuss them.

How to apply SVPs to hospital billing

Keeping it Simple: Whether or not to bill SVPs It’s why you’re seeing the patient that matters: if you’ve been called urgently or unexpectedly, it’s a Special Visit.  If it’s a scheduled or routine visit - even if it takes place in the evening or on a weekend – it’s not.

Special Visit Premiums can be confusing because of all the rules, restrictions, and limitations. First off, let’s define a special visit: 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: Billing Special Visit Premiums 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.