Alberta Health Care Insurance Plan AHCIP Claim Submission Seminar. New Members Jeffrey P Schaefer, MD July 14, 2010. Objective. Know the anatomy of an AHCIP claim Know the common situations Comprehensive Consultation Minor and Repeat Consultation Hospital Visits Emergency Detention
Alberta Health Care Insurance PlanAHCIPClaim Submission Seminar
Jeffrey P Schaefer, MD
July 14, 2010
Implicit Modifier Categoriesprogrammed into the billing softwareestablish your SKLL code (once)
Relevant Explicit Modifier Categoriesphysician must supply these
Possible Surcharges for the 03.08A(from the Price List)
Minor Consultation orRepeat Consultation (< 180 d)(same price)
03.08A + CMXC30 + 03.08I vs 03.04K1.5 hours is break pointless 03.08A more 03.04K
Total = $384.32
Emergency Detention per 15 minbedside attendance
INMD: 15, 30, eligible
Office / Clinic Visit Modifiers
CallbacksTypically used for patients you attend on. Pays less than new or repeat consultation
1. May only be claimed when a special call for attendance is made on the patient's behalf.
2. The physician responds to such a call from outside the hospital, on an unscheduled basis.
3. The patient is attended on a priority basis.
4. There is direct attendance by the physician.
5. Second or subsequent patients seen during the same callback are not eligible for benefits under 03.05N, 03.05P, 03.05QA, 03.05QB or 03.05R but time spent may be claimed using the AFTER HOURS TIME PREMIUM modifier.
6. May not be claimed in association with any health service code except 03.01AA. Refer to GR 15.8
Callbacks and Emergency Visits:Emergency Depts, Outpatient Departments, Auxillary Hospitals, Nursing Homes