The new Longitudinal Family Physician (LFP) payment model has arrived—and that’s welcome news for family physicians in British Columbia who have long been challenged by the structure and limitations of traditional payment models.
Key Components of the LFP payment model
Developed collaboratively with the Ministry of Health, Doctors of BC, BC Family Doctors and practicing family physicians themselves, the LFP payment model addresses a multitude of items on primary care providers’ wish lists:
- Adequate quality time with patients
- Compensation for time spent on indirect care/admin
- More equitable overall compensation
- Recognition for complex patient care
- Greater physician autonomy and flexibility
- Support for rising business costs
A significant departure from fee-for-service, the Longitudinal Family Physician payment model is a blended model that combines three core components:
- Billing for time
- Billing for patient interactions
- Payment for panel size/complexity
Notably, too, the LFP model uses just 11 fee codes, simplifying medical billing significantly.
The new payment model is a compensation option for family physicians who provide longitudinal, relationship-based care to a known panel of patients.
To qualify for the LFP payment model, family physicians must:
- Have a minimum panel of 250 active patients
- Provide longitudinal family medicine care (in-person and virtual)
- Provide the “Required Services” outlined in the LFP Payment Schedule (pages 2-3)
- Practice a minimum of 1 day per week (distributed equitably over the year)
- Provide a maximum of of 30% of services for non-panel patients
- Contribute to rent, lease, or other operating costs (either directly or indirectly)
How the LFP Model Compensates Physicians
Once you have determined you are eligible, it is then important to weigh the LFP model against your current payment model to see if it’s a good fit. BC Family Doctors has posted a compensation calculator for members to help make the comparison easier.
For basic context, a full-time family physician who works 1,680 hours a year who has a panel of 1,250 patients of average complexity and who has 5,000 visits from patients over the year will earn a minimum of $385,000.
As noted previously, the LFP payment model is based on compensation for time, interactions and panel complexity:
Billing for Time
Physician time spent on direct patient care, indirect patient care as well as clinical administration time will all be compensated at a rate of $32.50 per 15 minute period.
The LFP model has done away with “the greater portion thereof.” You simply total your number of cumulative 15-minute units of time over the whole day.
For billing, there are just three time codes in the LFP model:
|98010||Direct Patient Care||Time spent with patients providing services in-office, virtually or during home visits|
|98011||Indirect Patient Care||Charting, lab reviews, refills, care planning, referrals, asynchronous virtual care, travel time for home visits, clinical teaching when patient is not present, clinically required forms (including medical death certificates) and more|
|98012||Clinical Administration(max 10% of your total time per year)||Developing and maintaining active patient panel, proactive panel management (e.g. scanning for preventative care, annual shots, etc.), Medical Director and Privacy Officer visit responsibilities|
Note that the LFP model seeks to simplify billing. Regardless of actual patient diagnosis, time codes are always billed with diagnosis (ICD-9) L23, which is specific to the LFP model. (If your EMR does not yet recognize L23, use 780 for now.) If you bill with Dr.Bill, we are already set up to accept L23.
Further simplifying billing, you do NOT need to bill time codes for each individual patient, flip back and forth between direct and indirect patient care codes or bill a time code for every patient you see.
If you start your day seeing a patient for direct care at 9:00 a.m. and work through until 2:00 p.m. (providing both direct and indirect care for multiple patients without a break), the only time code that needs to be billed is 98010 for 5 hours (or twenty 15-minute units).
Patients who are not a part of your panel or on the panels of your partners (but who are seen during the time you are seeing LFP panel patients) can also be included in the time blocks for LFP patients. Keep in mind these “non-panel” patients must not exceed 30% of the total LFP and non-panel services each year.
The maximum combined time units that may be billed per day is 56 (14 hours). The maximum time units that may be billed over a rolling 14-day period is 480 units (120 hours). Time you spend providing service outside of your LFP does not count towards this limit.
As with fee-for-service, you must submit time code claims to HIBC via Teleplan within 90 days of the date of service.
Billing for Interactions
Patient interactions are accounted for in a simple set of 8 codes billed in addition to time codes. These can be billed for any patient interaction connected to your LFP clinic, whether it’s in-clinic, virtual or in a patient’s home setting.
|Code||Definition||Value (on top of time codes)|
|98031||In-person interaction at a clinic||$25|
|98032||Virtual interaction by phone or video||$25|
|98033||In-person interaction at patient’s home||$100|
|98034||In-person or video group interaction||$25/patient|
|98022||In-person interaction with a minor procedure or diagnostic test||$10 (max 2 per patient per day)This code may be added on top of both time + another interaction code|
|98021||In-person interaction with a standard procedure||$60 (max 1 per patient per day)|
|98020||In-person interaction with an advanced procedure||$110 (max 1 per patient per day)|
Fee-For-Service codes (such as those for tray fees and diagnostic tests) are not payable in addition to Patient Interaction Codes as these are taken into consideration in the overall LFP model.
Note that with the exception of adding 98022 when applicable, you will not bill more than one interaction code per visit. Simply choose the interaction code with the highest value that is applicable to your visit. There are no thresholds where interactions are paid at a lesser rate (e.g. 50%) as with some fee-for-service codes.
The maximum number of patient interaction codes payable in a single calendar day is 50 (not including code 98022 for minor procedures). Any services you provide that are not tied to your LFP clinic do not count towards your limit of 50 interactions per day.
As with fee-for-service, you must submit interaction code claims to HIBC via Teleplan within 90 days of the date of service.
When enrolling in the LFP payment model, you will be required to develop and submit an accurate list of active patients for whom you have accepted responsibility by July 1, 2023 (or within three months of enrolling in the LFP Payment Model—whichever is later).
Based on this list (minimum 250 patients), family physicians enrolled in the LFP payment model will receive an annual “panel payment.” The payment will vary based on the number and complexity of active panel patients submitted. For 2023, the panel payment will use the CLFP methodology. A new panel complexity calculator specific to the LFP model is in development for future years.
Each year you will confirm or update your active panel to ensure that your panel payment accurately reflects any changes in your practice profile.
Billing Outside of your LFP Payment Model
Note that care provided outside of the LFP model can still be claimed separately and in addition as per current practices (e.g. FFS). For example:
- Services provided in a facility (such as a hospital, LTC, rehab centre, etc.)
- Services provided under a contract or other payment model
- ICBC and WorkSafeBC claims
- Services to residents of other provinces/territories
- Medical Assistance in Dying
- Specialty insurance claims (such as Medavie Blue Cross, DND, RCMP, Refugees, Veterans Affairs)
- Third party and private billings for industrial exams, medico-legal forms, insurance forms, cosmetic work, etc.
How to Enroll in the LFP Payment Model
To enroll in the LFP model, you must first obtain a facility number for your LFP clinic via online application or printable form. Each clinic location must obtain a unique Facility Number. Only one Facility Number is required per clinic. If you already have a facility number, you can skip this step.
Once you have a facility number, you may enroll in the LFP Payment Model by submitting the zero-sum Registration Code 98000 to HIBC via Teleplan. Use the following “patient” demographic information:
Patient Surname: Portal
First name: LFP
Date of Birth: January 1, 2023
ICD-9 code: L23
It’s easy to set this up on Dr.Bill. Read our LFP support article for a quick walkthrough.
Physicians are advised to submit Registration Code 98000 five business days prior to submitting claims under the LFP Payment Model. Alternatively, you can start entering claims immediately for the LFP model, but hold them for 5 days before submitting to allow for processing time on MSP’s side.
Code 98000 can be submitted anytime during the year in your first year of enrollment in the FLP model. For subsequent years, you must submit code 98000 annually between Jan 1 and Mar 31 to stay enrolled.
Before enrolling in the LFP model, we recommend reading the LFP Payment Schedule thoroughly and utilizing the BC Family Doctors compensation calculator to compare this model against your current payment model. Though you can voluntarily withdraw from the LFP payment model
and transition to another payment model at any time, any physician who withdraws may not re-enroll for a period of 12 months unless approved in writing by the Medical Services Commission.
Frequently Asked Questions
Which patients can I bill for using the LFP model?
You can bill for any patients on your panel or who are on the panel of another family physician at your LFP clinic. Maternity services for patients not on your panel are also billable.
To be billed under the LFP model, these services must be provided at your LFP clinic, as a virtual care service associated with your LFP clinic, or to a patient in their home setting. Note that when providing virtual services, you do not need to be physically in your LFP clinic.
You can also bill for patients not on your panel and not on the panels of your colleagues; however, non-panel services (e.g. non-panel walk-in patients) may not exceed 30% of your LFP practice.
What if the other physicians in my clinic do not enroll in the LFP payment model?
It is perfectly fine for you to be the only physician on the LFP model in your team/group/partner clinic. Patients you see for your colleagues will be included in this model (not considered non-panel patients) regardless of what model your colleagues use.
Can I bill for work done by other clinicians, nurses, allied health professionals or MOAs?
No. Currently the LFP model only pays for physician work and time. You can not bill for the work or time of other professionals that you delegate to (though conversations with government about how team-based care will be supported are ongoing). However, you may bill for your indirect time for talking to learners about a patient following the visit. You can also bill for your indirect time if the learner calls, texts or otherwise consults with you during a patient visit. The simple distinction is that you can bill for your work and time, but not another team member’s.
Why is there no counselling code?
Unlike fee-for-service, you decide what warrants counselling. If you choose to provide counselling, your time is covered under the time and interaction codes. There is no limit on the time that may be spent counselling patients or the number of counselling interactions per year.
How do I bill for time spent on-call?
If you are on-call and don’t receive any calls, you don’t bill for that time. However, if you start taking calls or seeing patients, you bill for that time. Your time spent working on-call accumulates. For example, if you take three 5-minute calls, that is one 15-minute time unit.
Are locums eligible for the LFP payment model?
Soon! An agreement has been reached to extend a version of the LFP payment model to locums in the near future (as soon as the first half of 2023, though no firm date has yet been established). Once implemented, locums will be able to bill for time and interactions, but not panel payments (though long term locums may want to negotiate a portion of the panel payment when taking a position).
Where to Find More Information
If you are considering the LFP payment model, we highly recommend watching the Longitudinal Family Physician (LFP) Payment Model Webinar hosted by Doctors of BC for a deep explanation of how it works.
Additionally, you can consult the following resources to learn more:
At Dr.Bill, we are LFP-model-ready and are here to answer your questions about billing on this new model. Please contact us with your questions and we will respond within one business day.