FAQ – Amendment 195

LE 368

If a group of physicians is formed at my GMF, am I obliged to join?
No. Each physician’s participation is on a voluntary basis.

I am part of a group of doctors who have taken 500 patients in group registration. Am I responsible for scheduling appointments for these patients?
No. Patients registered as a group are referred to the GAP Access Point in their area who will arrange the appointment through the orchestrator. However, for follow-up agreed upon between you and the patient, the appointment is made directly by the practice.

Can I decide to take on individually a GAP patient registered in my group practice?
Yes, the fact that a patient is registered in the group practice does not prevent you from registering the patient individually with you, thereby terminating the patient’s group registration.

Can I bill the Family Medicine, Client Management and Follow-up Services Special Agreement (40) supplements for GAP patients?
No. However, supplements can be claimed for patients you take on individually.

I have accepted the role of lead physician in charge of my group. What exactly is my job?
The lead physician in charge of the group must :

- Contact your DRMG to determine the number of patients the practice can enroll in the group and have the GACO assign these patients;
- Consult the GAP report that will be sent every quarter to ensure the group compliance with the thresholds established according to the data extracted from the orchestrator;
- If the established thresholds are met, allocate the packages to the participating physicians based on their contribution to the services provided to the patients enrolled in the group.

Does the role of lead physician in charge of the group provide for additional compensation?
No.
What are the thresholds and conditions that must be met each quarter to claim the packages?

- The physician group’s offer of medical services, as measured by the orchestrator, must be one appointment slot per year, per patient collectively registered with the practice;
- The patient registered in the group must be offered the same services as those offered to patients registered with any of the physicians in the practice.

What happens if the conditions are not met?
The packages provided for in this Letter of Agreement will not be payable for the quarter in question.

If I have seen patients since June 1 who are on the group registration list of my practice, can I modify my claims to bill for a follow-up visit and the vulnerability premium when applicable?
Yes, you have 90 days to submit or change your billing.
Is it possible for a physician who sees a patient from the group registration list to add one or several vulnerability conditions to that patient’s file?
No. Vulnerability conditions can only be added to patients registered with the physician. They cannot be added to patients from the group. However, only for the Visite de suivi can the code for a vulnerable patient be used. For those, the modifier Patient inscrit en groupe selon la LE – Accès à l’offre de services en première ligne must be applied.

Mon GMF a déjà la désignation accès-réseau. Est-ce que la procédure d’inscription en groupe est la même que dans les autres cabinets?
Yes.
Do I need to add or change anything in my billing to receive the quarterly compensation?
No, if the firm follows the terms of agreement, you will be paid according to the orchestrator’s data.

Are the packages related to the new GAP measures subject to the different pay increases provided for in Annex XII and XII-A?
Yes.
If I participate in the GAP measures, could I be penalized according to the terms and conditions concerning the attendance rate as described in paragraph 15.06 of EP 40 – Family Medicine, Client Management and Follow-up?
No. If you participate in any of the measures, the financial implications of the attendance rate in paragraph 15.06 of EP 40 – Family Medicine, Client Management and Follow-up are suspended.