The time based component of the PCPCM compensates physicians for time spent on direct and indirect patient care. When billing for PCPCM time, the following are some key points to remember:
Claims for time-based codes are submitted for each day of service.
Physicians should claim time when the majority of the patients they have seen during the day are part of their panel.
Time should be billed in addition to encounter billing and the physician should subtract time spent on out-of-basket and uninsured services when calculating the time to bill.
Up to 20% of total time-based billing (per fiscal year) can be billed using the after-hours premium rate.
An example of how to calculate PCPCM time can be found on the AMA website here.
You can bill these codes on Dr. Bill by following the steps below:
To bill for PCMCM time on Dr. Bill, you will need to first enter the Non-Patient Specific Unique Lifetime Identifier (ULI): 10814-7612 in the “Patient” field on the claim form.
2. Next, enter the date of service for the day that you are billing time for in the “Date of Service” field.
3. Enter the PCPCM time-based code that you would like to bill into the “Health Service Code (HSC)” field on the claim.
4. Next, add the amount of calls for the time spent into the “unit” field. Once you add the calls to the field, the amount of time will calculate next to the field as well as an estimate amount for the claim. You can add additional PCPCM time-based codes to the claim for the same date of service by clicking the “+ Add Another” option.
5. When billing time-based and encounter based codes for PCPCM, be sure that your PCPCM BA is entered on the claim. You can switch between multiple BA numbers (such as Fee-for-Service and PCPCM) by clicking the “Choose” button next to the “Business Arrangement” field in the “Payment” area on the claim.
6. Finally, save the claim by clicking the “Save” bottom at the bottom of the claim form.
If you still have questions, write to us at hello@dr-bill.ca.
Happy Billing!