RACE billing information for family physicians, nurse practitioners, and midwives

Conversation must take place within two hours of the FP’s request and must be physician to physician. Not payable for written communication (i.e. fax, letter, email).

Fee Includes:

• Discussion with the specialist of pertinent family/patient history, history of presenting complaint, and discussion of the patient’s condition and management after reviewing laboratory and other data where indicated.

• Developing, documenting and implementing a plan to manage the patient safely in their care setting.

• Communication of the plan to the patient or the patient’s representative.

• The care plan must be recorded in patient chart and must include patient identifiers, reason for the care plan, list of co-morbidities, safety risks, list of interventions, what referrals to be made, what follow-up has been arranged

Not payable to the same patient on the same date of service as fee item PG14077.

Not payable to physicians who are employed by, or who are under a contract to a facility, who would otherwise have provided the service as a requirement of their employment or contract with the facility; or physicians working under salary, service contract or sessional arrangement.

Include start time in time fields when submitting claim.

Not payable for situations where the primary purpose of the call is to:

• Book an appointment

• Arrange for transfer of care that occurs within 24 hours

• Arrange for an expedited consultation or procedure within 24 hours

• Arrange for laboratory or diagnostic investigations

• Convey the results of diagnostic investigations

• Arrange a hospital bed for the patient.

• Obtain non-urgent advice for patient management (i.e. not required within the next 24 hours).

Limited to one claim per patient per physician per day.

Out-of-Office Hours Premiums may not be claimed in addition.

Maximum of 6 (six) services per patient, per practitioner, per calendar year.

Payable in addition to a visit on the same date.

Reciprocal billing for out-of-province (Yukon) patients requires: code for the province/territory of patient residence, PHN, name, sex, date of birth, and patient home address.

For physicians enrolled in the LFP Payment Schedule conferencing, consulting, and meeting with other physicians and/or other health professionals for a specific patient(s) is an eligible Indirect Patient Care (98011) activity. Click here to review the most up to date payment schedule to ensure appropriate billing for time spent on a RACE call, or contact LFP.billing@doctorsofbc.ca.