Tariff of Fees for Insured Medical Services Regulations (O.I.C. 81-379)

0 Certified to be a true copy of an Order of his Honour the Governor of Nova Scotia in Council made the EXCUTVE coUNCIL Lieutenant 24th day of March A. D. 1981 N. S. Reuhton NOVA scoriA _3i/_’) 81-379 / The Governor in Council on the report and recommendation of the Minister of Health dated the 13th day of March, A... D., 1981, and pursuant to clause (a) of subection (1) of Section 11 of Chapter 8 of the Statutes of Nova Scotia, 1973, the Health Services and Insurance Act, and subsection (3) of Section 4 of Chapter 15 of the Statutes of Nova Scotia, 1973, the Regulations Act, is pleased to: (a) approve and authorize payments by the Health Services and Insurance Commission in respect of the tariff of fees for insured medical services attached to and forming part of the report and recommendation, and marked Schedule “A”, effective for a period of one year, comrnencing.on the 1st day of April, A. D., 1980, at a rate of 85% of the fee so calculated; and (b) order that the publication of this regulation be dispense4 with due to the length of the Schedule attached to and forming part of the report and recommendation. 1-3. H F. G. STEVEiS, Q..C., CLEKOF THE EXECUTIVE COUNCIL. 5/1 SCHEDULE “A” TABLE OF CONTENTS PREAMBLE 2 UNIT VALUE SYSTEM 21 MISCELLANEOUS FEES 22 FAMILY PRACTICE 24 ANAESTHESIA 26 DERMATOLOGY 29 INTERNAL MEDICINE 31 NEUROLOGY 33 PHYSICAL MEDICINE AND REHABILITATION 35 PABDIATRICS 37 PSYCHIATRY 39 DIAGNOSTIC AND THERAPEUTIC PROCEDURES 41 GENERAL SURGERY 51 NEUROSURGERY 75 OBSTETRICS AND GYNAECOLOGY 82 OPHTHALMOLOGY 87 OTOLARYNGOLOGY 92 ORTHOPAEDIC SURGERY 98 PLASTIC SURGERY 116 UROLOGY 124 RADIATION ONCOLOGY 133 PATHOLOGY CONSULTATIONS 134 INDEX 150 —- — — e • r.. -. 5/2 PREAMBLE INTRODUCTION This 1980 edition of the Fee Schedule represents an updating of the 1967 (revised) Schedule. Future revision of this Schedule will be carried out on an on-going basis with major changes being promulgated annually. This Schedule of Fees is set up in Sections for each of the recognized Spe cialties together with the fees for consultations, visits, miscellaneous items, diagnostic and surgical procedures usually associated with each Section. Specific operative procedures are classified under Incision, Excision, Introduction, Repair, etc. There is a separate Section for Diagnostic and Therapeutic Procedures. 1. TARIFF Please note that the M S I tariff is 85% of the fees negotiated between the Health Services and Insurance Commission and the Medical Society of Nova Scotia. 2. GENERAL CONSIDERATIONS 2.1 This Schedule of Fees is to be used as a guide and represents in the average case a fair return for services rendered by physicians licensed to practice in the Province of Nova Scotia. The mdi vidual physician; however, has the right to establish the value of his services at all times. 2.2 Prior discussion with the patient regarding fees is recommended. 2.3 A reduction in fee may be made at the discretion of the physician when— (i) the suggested fee could prove a financial hardship to the patient; (ii) services are rendered at the convenience of the physician for chronic or prolonged illness. 2.4 A fee higher than the suggested Schedule may be charged at the discretion of the physician when - (i) complications occur and/or circumstances exist demanding unusual skill, responsibility and time; (ii) the patient requires or demands extra attention. 1VOTE: Under M S I, when a physiciai charges above the tariff, refer to the M S I Physicicuz’s ManuaL, for the proper procedure (page 8/1). .. - --. t -.-- b.i - -:--- - .. -a 7?’T . ‘r-’ ‘:‘ —--—- - ::: —-- - — .. —,.... — — .1 —.-. M - — I, ( —.- ...L._ 4 . ._.2 . 5/3 Services Insurance, in the1 2.5 Fees disputed with Nova Scotia Medical of the Medical first instance should be brought to the attention solution, the Director of Maritime Medical Care and, failing M S I Physician’s Appeal Procedures out-lined in Chapter 3 of the Manual should be followed. discretion of Advice by telephone or letter may be charged at the 2.6 Medical. the physician. (Not an insured service under Nova Scotia Services Insurance). use of the 2.7 Mileage is to be charged on a ‘time basis’ by the an ‘Detention Fee’ explained on page 8 of the Preamble. (Not insured service wider Nova Scotia Medical Services Insurance). for professional 2.8 Fees listed (unless otherwise indicated) are for drugs, services only and are not intended to cover charges injectible materials, dressings or appliances used in rendering items medical care. An additional charge may be made for such where appropriate. (Not insured services wider Nova Scotia Medical Services Insurcuzce). 3. PRINCIPLES OF ETHICAL BILLING of a 3.1 Each medical practitioner who participates in the care patient is entitled to compensation commensurate with the services rendered to the patient. the 3.2 The attending physician, whenever possible, should acquaint patient or person responsible with the financial obligation in volved in his care. This applies particularly when more than one physician is involved or when the patient is referred outside the Province. should 3.3 Each physician who participates in the care of a patient render directly to the patient, or to the financially responsible’ party, an itemized statement of charges for his professional services. This statement should clearly separate professional services from supplies. 3.4 A patient is entitled to receive a receipt for all payments made • by him or on his behalf directly to the physician. 3.5 Any statement of charges from an organized clinic or partnership should specify the fees for services rendered by each and every member of the group. 3.6 It is expected a physician will not charge for services provided to his own family. •. I r -r I - - -. -.. .. —. ———i • •—t--.-.--.f. • • - -——• .— — — ••-7• - 7 5/4 4. TERMS AND DEFINITIONS 4.1 Visits Call or visit refers to services by a physician to a patient for diagnosis and/or treatment at home, office or hospital. 4.2 Emergency Visit Emergency visit refers to a situation where the demands of the patient and/or the physician’s interpretation of the condition is such that he respond immediately at the sacrifice of regular office hours. The need for immediate response is the intended controlling feature. This would not apply for a patient attend— ing your office during regular office hours. Immediate attend ance because of personal choice or availability is not considered an emergency visit. Urgent visits for acute or chronic con ditions which do not interfere with regular hours do not consti tute emergency visits. 4.3 Urgent Care - Request by Patient A request by a patient for urgent care (as opposed to emergency care) which is provided by a physician outside normal office hours entitles the physician to a fee for a home visit for the first patient seen. Subsequent patients attended at this time - regular office visit fees apply. Where office hours are maintained in the evenings, on Saturday, Swday or holidays, or where patients are seen at the convenience of the physician at these times, regular office visit fees apply. 4.4 Initial Visit Initial visit refers to the services rendered a patient when the physician has not rendered medical care during the previous 30 days. 4.5 Subsequent Visits Subsequent visits refer to continuing services during any illness. 4.6 Continuing Care Visits Continuing care visits apply following a consultation at the request of the referring physician (see concurrent care 12.3.3 page 5/12. - r. .; ... •. : --- I.’ L .... • - -— .. - -.- —. -S - •. - --..--,•. -.- . — •. -— . .. .. - •. — . -. ••- -. ..s . — p . r ‘--•.•‘ -: — *1. — •___ — — _ — 4 — — 5/5 4.7 Directive Care Visits Refer to concurrent care 12.3.2 page 12 for details of circuin— stances in which directive care applies. 4.8 Visits for Procedure Only When the sole reason for a visit is the performance of a certain procedure, the listed fee for the procedure only will apply — except where otherwise specified. 4.9 Hospital Visit Hospital visit refers to services rendered a patient formally admitted to hospital for diagnosis and/or treatment. A physician may only charge for visits made for, or procedures performed on, those patients actually seen. 4.10 Out-Patient Department or Emergency Room Visits When the physician is required to make a special trip to the hospital to attend a patient in the Out—Patient or Emergency Department, the visit fees to apply will be found in the mis cellaneous section of the MSI Tariff. 4.11 Emergency Care Centre Visits Emergency Centres must meet the criteria established by the Health Services and Insurance Commission. 4.12 Home Visit A home visit is a visit rendered to the first patient seen follow ing travel to the patient’s home. The appropriate home visit fee will apply. 4.12.1 Extra Patients at Home Visits Extra patient refers to an additional member of the same family or person living in the same home or institution and seen or prescribed for during a visit to that home or institution. 4.12.2 Follow-Up Home Visits When follow-up home visits are made at the convenience of the physician, the week day home visit fee will apply regardless of when the visit is made. - — ‘ r a -‘V. ,_,,4.,., —, — — — —— — — — — . — —, — — — — — — : £ —— • 5/6 1 4.13 ge Definitions 4.13.1 ‘Child’ refers to a person 15 years of age or younger. 4.13.2 ‘Adult’ refers to a person 16 years of age or older. 5. INSTITUTIONAL VISITS When a visit is made to a patient in an institution on the specific request of an appropriate institutional authority, patient or patient’s family/guardian, the rules and fees for home visits shall, apply.

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