The Longitudinal Family Physician (LFP) Payment Model, introduced by the Ministry of Health in British Columbia on February 1, 2023, has continued to evolve over the past two years. As of 2024, over 4,000 physicians have enrolled, demonstrating the growing adoption of this model. For our OSCAR Pro users, understanding the latest updates is crucial to ensuring seamless billing and patient management. In this blog, we share a breakdown of the key changes and clarifications that may impact your practice.
LFP Payment Model Billing & Payment Adjustments
New Temporary Billing Code for Allied Care Provider Immunizations
Between October 1, 2024, and March 31, 2025, physicians can bill for influenza, pneumococcal, pertussis, and COVID-19 immunizations administered by allied care providers in their practice. Use the billing code 98101 (LFP Respiratory Immunization Provided by an Allied Care Provider) to claim these services.
Note: The allied care provider must be employed directly by the practice with no external funding or cost recovery from third parties.
Time Code Billing Restrictions
Physicians must adhere to following limits when billing for clinic-based care:
- Maximum daily hours: 14 hours a day
- Maximum biweekly hours: 120 hours per 14-day period
- Administrative time cap: Clinical Administration (codes 98012, 98042) cannot exceed 10% of total clinic-based time codes in a calendar year.
To avoid claim rejections, ensure that start and end times do not overlap when submitting multiple claims for the same day.
Billing for Virtual and In-Person Visits on the Same Day
If a patient is seen virtually and later requires an in-person visit on the same day, billing rules apply:
- A second patient interaction code cannot be billed unless the second visit is for a new condition or a significant worsening of an existing condition.
- Time for each interaction must be clearly documented.
- Submission code “D” is required for the second claim.
Clarification on Phone Consultations and Billing
- Physician-to-physician consultations regarding a patient are billed under indirect patient care.
- Phone consultations with patients regarding lab results can be billed under 98032, in combination with 98010 (time billing), but not in 0.5 units.
Patient Enrolment & Panel Payments
Patient Panel Requirements
Physicians do not need to have an existing patient panel before enrolling in the LFP model. However, they must meet these requirements:
- Within four months: Maintain a minimum of 250 empanelled patients.
- Within three months: Submit an accurate patient panel list. Regular updates are encouraged.
Panel Complexity Calculation
Panel payment amounts for 2024 are calculated using the Community Longitudinal Family Physician (CLFP) Payment methodology:
- Patient numbers are determined using the Majority Source of Care (MSOC) methodology.
- Complexity is measured using the Adjusted Clinical Group (ACG) system.
- Tip: Use all three Dx spots when applicable to ensure complexity is fully captured.
Exclusions & Special Considerations
CLFP Payment and the LFP Model
Physicians transitioning to the LFP model will no longer receive CLFP payments. Instead, they will receive panel-based payments reflecting the size and complexity of their patient population.
ICBC, WorkSafeBC, and RoadSafetyBC claims must be billed separately through fee-for-service (FFS), as they are not covered under the LFP model. If an unrelated condition is treated during the same visit, interaction code 98031 may be billed separately, provided the (Dx) code differs from the FFS claim.
Time codes are not payable under the LFP Payment Schedule for any part of the patient interaction, including time spent on services covered by the LFP model. When billing WorkSafeBC on the same day as LFP-covered care, start and end times must be recorded for the FFS claim.
Non-Panel Services Transition Period
Physicians may provide services to patients who are not on the panel of any longitudinal physician or nurse practitioner at the same LFP Clinic. However, non-panel services must not exceed 30% of the clinic’s LFP-based services.
For those exceeding this limit, a transition period is in place until June 30, 2025. During this period, a longitudinal family physician must submit an LFP Clinic-based Services Transition Code (98001) after the Enrolment Code to indicate they are temporarily above the 30% threshold. By doing so, they confirm their commitment to adjusting their practice to meet the requirement by the deadline.
Locum Physicians & LFP Model
Locums must enroll in the LFP model before submitting claims. Here are the steps to enroll:
- Submit Locum Enrolment Code (98005) via Teleplan.
- Complete and submit the LFP Locum Registration Form at least one business day before billing.
Locums have dedicated interaction and time codes under the LFP model, which can be found in the LFP Payment Model Schedule.
LFP Payment Model Key Takeaways for OSCAR Pro Users
- Ensure billing is aligned with updated time code restrictions and virtual/in-person visit guidelines.
- Maintain an accurate patient panel to maximize panel payments.
- Use correct billing codes for ICBC, WorkSafeBC, and non-panel services.
- Locums must enroll separately and follow their designated billing structure.
For more details, visit the updated LFP payment schedule.
Have questions on this works in your EMR? Contact us today at help@oscarprodesk.ca.