Reporting / Billing

This companion document (FAQs) is not a legal document, nor is it legally binding. This document is intended to help you understand the clinical ARP framework, but the language in the Clinical ARP Program Parameters and the Conditions of Payment Ministerial Orders (MOs) ultimately speaks for itself. In the event there is a discrepancy between this document and the provisions in the signed MOs, the signed MOs shall be paramount. 

Reporting/Billing

Are the terms shadow billing and service event reporting interchangeable?

Yes, shadow billing and service event reporting can be used interchangeably. Both refer to the submission of health service claims for clinical ARP program services provided by the physicians, using either Schedule of Medical Benefit codes or approved Allied Procedure List codes.

Can a participating physician work more or less than 1.0 full-time equivalent (FTE) in a clinical ARP?

Physicians are able to work any portion of a full-time equivalent (FTE) up to the approved individual and program maximums for the clinical ARP as outlined in the Conditions of Payment (CoP). A physician may be able to work up to a maximum of 1.5 FTEs in a fiscal year (April 1 to March 31), provided that the sum of all individual physician FTE totals are within the maximum FTE funding for the program and the program meets all other qualifying conditions as outlined in the CoP (e.g., minimum of participating physician or FTE rule). All changes to individual physician FTE amounts should be approved by the authorized representative to ensure the program remains within the maximum full time equivalent allotment.

What services should physicians report when shadow billing?

Program services can be provided through direct or indirect patient care. For all indirect and direct patient care activities, it is important to capture the complexity and time spent. As with fee-for-service, ARP physicians submit claims using the appropriate codes from the Schedule of Medical Benefits (SOMB). If a SOMB code does not exist to capture an indirect program service provided (e.g., case conference, telephone contact, administration), then use an approved Allied Procedure List (APL) code to report the service. If you are unsure of which APL code your program is eligible to use, check with your Alberta Health Policy Analyst or ARP PSS Consultant.

Why is it important to shadow bill for all services provided in a clinical ARP?

Under clinical ARP Ministerial Order, physicians are required to submit claims for all clinical ARP services provided in order to qualify for payments. Shadow billing data is a key factor in determining the level of future funding approved for the program (i.e., for future program expansion requests).

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