GPSC is implementing new rules for family physicians billing codes 14070 and 14071, starting January 1, 2021. Before you bill 14070 and 14071 this year, check the billing rules on the GPSC website to ensure that you meet them.
Community Longitudinal Family Physicians
“Community Longitudinal Family Physician” (CLFP) is the name chosen to replace “Full-Service Family Physician” throughout the GPSC fees. The change in term comes with an expanded definition which means new rules for submitting 14070.
Submitting fee code 14070 signifies that:
- You are a Community Longitudinal Family Physician (CLFP,) as defined in the GPSC Preamble, with an office from which you provide in-person medical services to a known panel of patients;
- You are the Most Responsible Physician/Provider (MRP) for the majority of the patient’s longitudinal primary medical care, providing continuous comprehensive coordinated family practice services to your patients, and will continue to do so for the duration of that calendar year;
- You are confirming your doctor-patient relationship with your existing patients through a standardized conversation or ‘compact’;
- You are able to produce a list of active patients for whom you are the MRP
What is a “Community Longitudinal Family Physician?”
For the purpose of GPSC incentives, a family physician is working as a “Community Longitudinal Family Physician” when they do all of the following:
- Assume the role of Most Responsible Physician/Provider (MRP) for a known panel of patients.
- Confirm patient-physician relationship with their patients through a standardized conversation or “compact”, as outlined in PG14070.
- Provide, or coordinate delivery of, longitudinal full scope family medicine primary care services to a patient panel that is inclusive of patients of diverse demographics and medical needs.
- Work in community settings such as physician offices or health care clinics where patients are seen in person. CLFP may also provide some virtual services to their patient panel via telephone, video or other virtual care modality. CLFP may also provide some services to patient panel in facility settings such as hospitals, long term care, hospices, assisted living, or group homes.
- Maintain the comprehensive longitudinal medical records of each patient on patient panel.
A family physician is NOT considered to be working as a CLFP while they are working solely in one or more of the following health care settings:
- Episodic care settings such as, but not limited to, walk-in clinics, urgent care centres, and hospitals where physician does not assume the role of MRP for patients.
- Virtual care settings where patient care is delivered via telephone, video, or other virtual care modalities.
- Focused practices serving a specific patient population or providing sub-specialty services such as, but not limited to, maternity care, palliative care, sports medicine, chronic pain, and addiction care.
- Facility settings such as, but not limited to, hospitals, long-term care, hospices, assisted living, or group homes.
Locum Physicians
The new Locum Community Longitudinal Family Physician portal (14071) more clearly defines when locums may use various fees.
Submitting fee code 14071 signifies that:
- You are providing community longitudinal family practice services to the patients of host physicians, and will continue to do so for the duration of any locum coverage for a family physician who has submitted 14070.
Physicians with a Focused Practice in Long Term Care
Physicians who have a focused practice in long-term care and who do not work in a community-based longitudinal family practice may no longer meet the eligibility requirements of 14070 or 14071.
If you have a focused practice in long term care, there will be a new Long Term Care (LTC) portal code (14072) for you to bill in 2021. The new LTC Portal gives access to billing codes Chronic Disease Management fees (14050, 14051, 14052, 14053) and Conferencing/Communication fees (14076, 14077, 14078).
On a temporary basis, until the new LTC Portal (14072) becomes available in early 2021, physicians with a focused practice in long-term care are able to submit 14070 (or 14071 for locums) for the purpose of accessing Chronic Disease Management fees and Conferencing/Communication fees. Once 14072 is available, you must submit 14072 to signify you are working in a focused practice in long term care for the duration of 2021.
Note: Physicians who work in a community-based longitudinal family practice in addition to long term care may continue to submit 14070 (or 14071 for locums) provided they meet all the requirements.
Physicians working under Alternative Payment/Funding Models
If you provide services under an Alternative Payment/Funding Model, you are not eligible to submit 14070 or 14071 for the portion of your medical practice funded this way.
You remain eligible to bill Chronic Disease Management fees (14250, 14251, 14252, 14253), Patient Telephone Management Encounter (14276), and ACP Practice fee (14029).
If you have questions about the changes to the GPSC Portal Codes, please check out our Billing Help Library. We have answers to the most frequently asked questions about the changes to these fees.
You can also read more on the GPSC website. If you have any questions, please contact [email protected].