Objective of the Program
- Primary Care Clinics
To provide regularly scheduled primary care clinics to outlying communities with Underserviced Area Program (UAP) funded nursing stations or medical clinics. - Physician Telephone Back Up
To provide direct, 24-hour emergency physician back up to the nurse/nurse practitioner working in UAP nursing stations/clinics.
Definition
- Primary Care Clinics
A program where authorized physicians under arrangement with the UAP travel to provide primary care services at UAP nursing stations/clinics for up to two clinic days per week. - Physician Telephone Back Up
Authorized physicians under arrangement with UAP provide formal back up by telephone for delegated acts to nurses/nurse practitioners working in UAP nursing stations/clinics. The physician(s) provide immediate and direct telephone back up to nurses/nurse practitioners requesting assistance.
When authorized physician(s) are unable to provide immediate and direct back-up to the nurse/nurse practitioner, the nursing station/clinic is provided with the name and telephone number of an alternate physician prior to the authorized physician taking leave of his/her telephone back-up responsibilities.
Remuneration
- Primary Care Clinics
- fee-for-service plus $210.02 honorarium for each day of outreach service or
- stipend of $525.04 plus $210.02 honorarium for each day of outreach service.
Physicians are encouraged to bill fee-for-service rather than stipend on days that at least $525.04 can be billed to OHIP.
A day of "outreach service" consists of a maximum of six hours (this includes clinic time and travel to and from the physician's normal place of practice). The minimum length of a clinic is two hours. Neither the stipend nor the honorarium may be claimed for clinics of less than two hours. For less than six hours of outreach service (i.e., the minimum two-hour clinic plus travel time) the $525.04 stipend will be pro-rated accordingly while the honorarium remains at $210.02.
When weather conditions cause the early closure of the clinic, please notify UAP immediately. A decision regarding payment for the day will be made based on the circumstances. When a physician is unable to travel to a nursing station/clinic for the purpose of providing an outreach clinic due to poor weather conditions, no payment for stipend or honorarium will be made.
- Physician Telephone Back Up
$315.02 per month per UAP nursing station/clinic covered. This amount may be shared between two or more physicians. - Direct Deposit
All payments for services rendered are made by direct bank deposit. A physician must provide a blank, voided cheque to identify his/her account and enable UAP to set up a direct deposit account. - Northern Group Funding Plan (NGFP)
Physicians who are under NGFP payment arrangements and provide outreach clinics in UAP nursing stations/clinics, cannot claim honorarium or stipend. Physicians will be paid for mileage to and from the nursing station/clinic. Following are annual kilometer rates for use of a personal vehicle, as the number of kilometers increase, the reimbursement rate decreases :
Northern Ontario 0 to 4,000 km 41¢/km 4,001 to 10,700 km 36¢/km 10,701 to 24,000 km 30¢/km more than 24,000 km 25¢/km
Billing
- Primary Care Clinics
For each day of outreach service performed, the nursing station/clinic staff must submit to UAP, on behalf of the physician, a "Physician Outreach Program Billing Statement", signed by both the nursing station/clinic and the visiting physician. The statement must indicate the total number of outreach hours broken down by clinic and travel time. - Physician Telephone Back Up
For each month of service, the physician(s) must submit to UAP a single letter or a "Physician Outreach Program Backup Services Billing Form" indicating the nursing station/clinic being served and requesting payment for authorized back-up services provided. - Accounts (statements of expenses, billing forms, etc.) and inquiries must be received by UAP within 90 days of the date of service to be eligible for payment. Claims received after 90 days will not be paid.
UAP is applying stringent examination of billing for stipends and fee-for-service claims. A physician may either bill fee-for-service or stipend on any approved outreach day, but claiming both types of payment for the same outreach day is prohibited. Note that this does not apply if a physician has provided office or on call services in his/her home community prior to providing service at the nursing station/clinic. Should instances of inappropriate billing be identified, the information will be referred to the Ministry of Health and Long-Term Care's Monitoring and Compliance department for review.
Health Care Professionals
