Frequently Asked Questions for Physicians
Manitoba’s Chronic Disease Management Tariffs
Q. When am I eligible to bill a CDM tariff?
A. In order to bill a CDM tariff a physician must meet all eligibility requirements stipulated in the tariff. Specifically, a physician must:
- be a General Practice physician;
- provide the majority of the patient’s ongoing comprehensive medical care in relation to the active management of the specific chronic disease(s) diagnosed;
- provide ongoing coordination with other allied health care providers respecting the management of the patient’s condition and patient care plan, as appropriate;
- provide ongoing communication with the patient, monitoring of the patient’s condition and patient care plan, as appropriate; and
- ensure that all of the required services for that particular tariff have been provided to the patient within the preceding 12 months.
Effective April 1, 2012, you may bill for the care that you are currently providing to patients with a diagnosis of Diabetes, Congestive Heart Failure, Coronary Artery Disease and/or Asthma, provided that all other requirements are met.
Effective April 1, 2013, you may bill for the care that you are providing to patients with a diagnosis of Hypertension, provided that all other requirements are met.
Each tariff may only be claimed once, per patient, in any 12-month period. Only one physician may claim each tariff for a single patient in a 12-month period.
Where a patient is treated for the management of more than one of the listed diseases, a tariff may be billed for each disease. Claims for additional services (e.g. visits) are payable in addition to these tariffs.
Q: Am I required to submit a separate claim for each CDM tariff associated with a single patient?
A: Yes. A separate claim needs to be submitted for each CDM tariff claimed. For example, two (2) separate claims must be submitted when billing CDM tariffs for both Diabetes (8431) and Coronary Artery Disease (8434) for a single patient. The ICD code for each claim must match the disease.
Q: How do claim submissions for the Chronic Disease Management (CDM) tariffs (8431, 8432, 8433, 8434, and 8435) differ from my other claim submissions?
A: Claims for the CDM tariffs should be submitted through your normal claims submission process. The difference is that these tariffs also require supporting information with respect to the management of the patient’s disease.
Q: What additional information do I need to submit when claiming Tariff 8432 for Asthma?
A: Claims for Tariff 8432 – Asthma - require a remark on the claim stating “Asthma Action Plan completed”
Q: What additional information do I need to submit when claiming all other CDM Tariffs?
A: Claims for all other CDM tariffs must be accompanied by supporting information. Supporting information must be documented on an approved Patient Care Treatment Form.
Physicians using a Manitoba-approved Electronic Medical Record (EMR) system will have the option of submitting supporting information through a data extract from their EMR in future. Manitoba Health is in the process of implementing systems that will enable this option. More information will be provided as it becomes available.
Q: When should I submit the Patient Care Treatment Forms?
A: It is recommended that you submit the Patient Care Treatment Forms on or around the same date that you submit your medical claim(s) for that patient.
Q. I am using a Manitoba-approved Electronic Medical Record (EMR) system. How can I get ready to submit supporting information by data extract?
A.If you are using a Manitoba-approved EMR and interested in using this option when it becomes available you may need to change your EMR configuration and use in order to capture the supporting information in your EMR in the appropriate format. Your Manitoba-approved EMR vendor can assist you. Please contact your Vendor or your EMR Adoption Program CSR for more information.
Q: Do I need to submit Patient Care Treatment Forms if I am part of the Physician Integrated Network (PIN)?
A: If you are participating in PIN, your PIN data extracts will contain the necessary supporting information, as long as all the required services have been completed for the patient in the preceding 12 months, and data about these services has been entered and extracted appropriately. Provided this is the case, you do not need to submit Patient Care Treatment Forms. You do still need to submit the associated medical claim(s).
