Alberta government schedule of benefit changes

The Alberta government is changing the time limit for practitioners to submit claims to the Alberta Health Care Insurance Plan (AHCIP) from 180 days to 90 days. This change applies to both new claims (90 days after the date on which the health service was provided or the patient was discharged from the hospital) and resubmitted claims (90 days after the date on the last Alberta Health Statement of Assessment on which the claim appeared). The change is effective March 31, 2020.

Good faith claims are ending. Alberta Health will no longer pay for claims submitted in good faith for patients without an Alberta Personal Health Number (PHN). The patient can be billed privately. However, if the patient subsequently provides an Alberta PHN, the private billing must be reimbursed to the patient and a claim submitted to Alberta Health. The change is effective March 31, 2020.

Physicians will no longer be able to receive compensation for overhead when a service is provided in a registered publicly funded facility. For example, codes 03.07A and 03.08A will be replaced by new codes, 03.07AZ and 03.08AZ respectively. These new codes will likely be of lower value. The changes are effective March 31, 2020. However, as the Claim Assessment System (CLASS) and publication of the revised Schedule of Medical Benefits are underway, the new codes may not be available by March 31, 2020. Physicians can continue to bill existing, soon to be replaced codes, but when the new codes are released, Alberta Health will re-assess impacted claims and recover additional compensation paid retroactively.

The Government will make changes to provide fixed funding amount to AMA for Medical Liability Programs. Previously, the Alberta government had provided funding such that medical liability insurance could be provided to all physicians with a $1000 deductible, regardless of the underlying premium cost. The AMA will need to assess new deductible amounts for different specialties.

The government is ending funding to the AMA for the Continuing Medical Education Program. The AMA will need to end or self fund the $2,684 previously provided to physicians for costs incurred with regard to the maintenance and enhancement of knowledge, skills, and competency.