Clinics using secure interface PCDE communications
All other clinics
Provide Manitoba Health with the location of the clinic (address and contact information), and number and type of practitioners providing services at that location
Click here and complete the form to register your clinic and request access to the enrolment portal. The Home Clinic team will work with you to provide guidance and answer your questions. The person(s) you designate to maintain enrolment information, usually a clinic manager or administrator, will be provided with a user ID and password for the portal.Clinic location and contact information is maintained in the portal. Initially, only information about main Primary Care Providers (Most Responsible Providers/MRPs) will be collected. In the near future, the portal will be enhanced to include the number and type of practitioners providing services at your clinic.
Establish Enrolment with patients
Patients may be enrolled using one of two methods:Communicating with the patient to establish an enrolment agreementThrough analysis of EMR chart data to infer a continuous, comprehensive relationship with the patient.Talk to the Home Clinic team to learn more about approaches to enrolment.
Communicate patient enrolment to Manitoba Health – Initial Bulk Enrolment
These can be communicated to Manitoba Health using the Primary Care Data Extract through your usual submission method. The Home Clinic team can help you with this process.
These can be communicated to Manitoba Health using the Primary Care Data Extract. The Home Clinic team can help you with this process and provide you with details on how to submit your data.
If you have questions about the Primary Care Data Extract, the Home Clinic team can help.
Communicate patient enrolment to Manitoba Health – Ongoing Enrolment
Log in to the portal and make changes (add/edit/terminate), through your regular monthly Primary Care Data Extract or using Enrolment Service (if implemented at your clinic).
Log in to the portal, and make changes (add/edit/terminate) to enrolled patient information.
Communicate the medical services consistent with the applicable indicators in the Manitoba Primary Care Quality Indicators Guide
Through your regular monthly Primary Care Data Extract. This is the same extract that will be used to update your enrolment records in the portal.
Send your Primary Care Data Extract (PCDE) on an encrypted USB or CD with submission form to:ATTN: PCDE Information Management & Analytics Manitoba Health 4040-300 Carlton Street Winnipeg MB R3B 3M9
1 This includes clinics who are using an EMR product that is certified against the PCQI Reminders and Data Extract specification.
2 This includes all clinics who are using EMRs that can create the PCDE, but send them in via encrypted CD or USB.
The purpose of this list of Frequently Asked Questions is to provide fee-for-service family physicians and Home Clinics information on the Comprehensive Care Management (CCM) Tariffs. The CCM Tariffs are tightly linked with becoming a Home Clinic and enrolling patients. For further information on Home Clinic and patient enrolment, please refer to the Shared Health website. The Manitoba Health and Manitoba eHealth websites provide complimentary information to help guide clinics on how to become a Home Clinic and also become eligible to claim the CCM tariffs.
What are the Comprehensive Care Management (CCM) Tariffs?
There are five CCM tariffs available as of April 1, 2017 to eligible physicians for the annual management of primary care for enrolled patients in the following categories:
Patients between 50 and 74 years of age without a chronic disease
Patients 75 years of age and over without a chronic disease
Patients diagnosed with one Chronic Disease
Patients diagnosed with two Chronic Diseases
Patients diagnosed with three or more Chronic Diseases
For the purpose of the CCM tariffs, “Chronic Diseases” shall be Diabetes, Asthma/COPD (COPD is only eligible as of April 1, 2018), Congestive Heart Failure, Hypertension, and Coronary Artery Disease.
What are the eligibility requirements to be able to claim the CCM Tariffs?
Manitoba Health has developed a web-based enrollment portal to be used for enrolling patients. This portal is called the Home Clinic Portal. Clinics that enroll patients are called Home Clinics.
Full details on the CCM tariffs including eligibility and other requirements will be published in the Manitoba Physician’s Manual on April 1, 2017. Prior to April, the new tariff numbers and tariff descriptions can be found on Health’s Claims Processing System (CPS) webpage.
Why do the CCM tariffs require that physicians claiming them belong to a “registered Home Clinic”?
In 2011, The College of Family Physicians of Canada released the report, “A Vision for Canada: Family Practice – The Patient’s Medical Home.” The goals and recommendations in this report have been a key factor in setting the strategic direction for Health’s Primary Health Care policies and planning around My Health Teams and Home Clinic Implementation, including recommendation 10.5 that states “Blended payment models should be introduced in every province / territory as a preferred option for remunerating family physicians in practices functioning as Patients’ Medical Homes.”
CCM tariffs support comprehensive care, which is different from episodic care. Home Clinics agree to provide comprehensive, coordinated and continuous care to their patients and enrolment is the process whereby the provider/clinic and the patient recognize and agree to this on-going relationship. The CCM tariffs are designed to support the coordination efforts required by the fee for service family physician in providing comprehensive care, recognizing that the interprofessional care team may be providing some of the hands-on delivery of care, which is another principle of the Home Clinic.
Note 2 of the CCM Tariff states: Tariffs may only be claimed by physicians who provide comprehensive care to enrolled patients and who have provided Manitoba Health Primary Care Branch with the location of the Home Clinic (address and contact information), and number and types of practitioners providing services at that location. Eligible physicians who choose to claim the CCM tariff will meet the clinic contact and provider information requirement by using the Home Clinic Portal to register their clinic as a Home Clinic, and by keeping the contact and provider information for their Home Clinic up to date.
What is involved in “registering” a Home Clinic?
To register as a Home Clinic, the clinic/practice must first agree to the conditions outlined by Health, which are aligned with the conditions of the CCM tariff, and, if agreeable, the clinic can then register with Health as a Home Clinic. The initial criteria to be a Home Clinic align with the requirements outlined in the CCM tariff rate table. Information on Home Clinics and the Home Clinic registration and patient enrolment processes can be found at the Home Clinic Registration webpage.
Why can CCM tariffs only be claimed for patients who are “enrolled”?
Enrolment is defined as the process by which a patient agrees to be registered to the Home Clinic as their main provider of primary health care and the Home Clinic agrees to provide comprehensive, continuous primary care and to coordinate with other providers as per the Home Clinic definition.
When a patient is enrolled with a Home Clinic, a Most Responsible Provider (MRP) is linked to the enrolled patient. The MRP is the provider who has the lead role and medico-legal responsibility for overseeing the patient’s care needs throughout their lifespan. The MRP provides ongoing, comprehensive primary care, including ongoing coordination with other health care providers, respecting management and monitoring of patient condition(s) and the patient care plan(s) and providing ongoing communication with the patient. A patient can have only one MRP at any point in time.
Most Responsible Providers (MRPs) will support the whole patient, not just illness, and they will focus on wellness, not just treatment. MRP’s will emphasize health promotion, chronic disease prevention and risk reduction, early detection of health problems, self-care, and evidence-informed chronic disease management, including mental illness, and will develop patient-centred strategies to ensure patients can make informed choices and are partners in care planning and management.
The tariff is not intended for episodic care provided by a clinic or a provider, and is therefore reserved for the family physician who is the one MRP for a patient.
How are patients “Enrolled”?
Patients may be enrolled using one of two methods: Active or Passive enrolment.
Active patient enrolment directly involves the patient in the enrolment decision. The process involves direct communication with the patient, and ensures their understanding of the benefits of Home Clinic enrolment. The communication also clarifies the responsibilities of both parties – the Home Clinic and the enrolled patient. When an active enrolment occurs, and there is an enrolment agreement, the date of the active enrolment is documented in the EMR as the Enrolment Start Date. An active enrolment communication can occur with new or existing patients, and also with patients who were initially passively enrolled. Review our active enrolment supports for Home Clinics.
Passive enrolment does not involve communication with the patient. Candidates for passive enrolment are identified by the Home Clinic through analysis of data within their Electronic Medical Record (EMR) system. Review our tips for this analysis before you get started.
What if I cannot get all my patients enrolled by April 1, 2017? Does this mean I cannot claim CCM patients until a year later?
Tariffs are payable only to the physician who has provided the patient ongoing comprehensive primary care during the preceding 12 months. The CCM tariff is payable if:
the patient is enrolled at the time of claiming the CCM tariff and;
the physician has provided the patient with ongoing comprehensive primary care during the preceding 12 months, even if the patient has not been enrolled for the full 12 month period.
If a patient declines to enrol with the Home Clinic, can a fee-for-service family physician still claim the CCM tariff?
No. CCM tariffs may only be claimed for enrolled patients for whom the fee-for-service family physician has provided the patient ongoing comprehensive primary care during the preceding 12 months.
Why did Health introduce the Comprehensive Care Management (CCM) tariffs? How are these substantially different from the CDM tariffs? Why do we have both?
The CCM tariffs are a component of the evolution towards the College of Family Physicians of Canada’s (CFPC) vision of the Patient’s Medical Home. Health recognizes that coordinating care for more complex patients with multiple chronic conditions takes additional effort. The purpose of the CCM tariffs is to support physicians in the provision of care to complex patients to promote continuity, comprehensiveness, coordination, access, and patient centered care.
The tariffs also encourage the use of interprofessional teams to support this care and promote preventative care to help patients stay well. Additionally, the requirement of an Electronic Medical Record (EMR) promotes the use of EMRs to support planning, evaluation, and continuous quality improvements.
There will be a transition period as clinics adopt the Home Clinic model. The CCM and CDM tariffs are both available to allow for this transition period.
Can I claim both a CDM tariff and a CCM tariff when I provide all the required care for a patient with a chronic disease?
No. The CCM tariffs can only be claimed once per patient during any twelve month period and cannot be claimed in combination with any other comprehensive care tariff including the CDM tariffs.
Can I claim a CDM tariff for one condition and a CCM tariff for a different condition, for the same patient?
No. The CCM tariffs can only be claimed once per patient during any 12 month period and cannot be claimed in combination with any other comprehensive care tariff including the CDM tariffs.
What if I submit a CCM tariff on a patient and another physician has already claimed a CCM tariff for that patient?
If a CCM tariff has already been claimed for that patient by another provider, the second CCM tariff in the 12 month period will be rejected. Providers will have the opportunity to query the rejected claim through the Informal Resolution of Disputes process detailed in the Claims Submission and Payment Procedures section of the Manitoba Physician’s Manual. The requirement that a CCM claim can only be made for patients who were enrolled to the claiming provider’s Home Clinic at the time the claim was made should reduce these conflicts. In the event that conflicts do still arise, preference will be given to the provider who is either documented as the Most Responsible Provider, or who provides evidence that they have provided the majority of continuous, comprehensive care to the patient as it relates to prevention and chronic disease management.
What type of documentation will be required to support CCM claims?
Physicians must use an EMR and document enrolment status and medical services consistent with the applicable indicators in the Manitoba Primary Care Quality Indicators Guide in the EMR.
Physicians must provide periodic data extracts to Health in a provincially-approved format, through a secure data transport mechanism. While you do not need to use a certified or approved EMR product, your EMR must be able to produce the Primary Care Data Extract. For more information on the Primary Care Data Extract, please refer to the Manitoba eHealth EMR Certification site.
My clinic focuses exclusively on walk-in care. Am I eligible to claim CCM tariffs?
No. The focus of the CCM tariffs is for clinics that provide comprehensive, patient centred care, and not on episodic care. Clinics, such as QuickCare or fee-for-service walk-in clinics that only provide episodic care would not be eligible.
What if I submit a CCM tariff on a patient and another physician has already claimed a CDM tariff for that patient?
If a CDM tariff has already been claimed for that patient by another provider within the last 12 months, the CCM tariff will be rejected. Providers will have the opportunity to query the rejected claim through the Informal Resolution of Disputes process detailed in the Claims Submission and Payment Procedures section of the Manitoba Physician’s Manual. Priority will be given to the Home Clinic to which the patient is enrolled, and to the Most Responsible Provider, that is the provider who provides patient-centred comprehensive care including prevention and chronic disease management.
What if I submit a CDM tariff on a patient and another physician has already claimed a CCM tariff for that patient?
If a CCM tariff has already been successfully claimed for that patient by another provider within the last 12 months, the CDM tariff will be rejected. Providers will have the opportunity to query the rejected claim through the Informal Resolution of Disputes process detailed in the Claims Submission and Payment Procedures section of the Manitoba Physician’s Manual. Priority will be given to the Home Clinic to which the patient is enrolled, and to the Most Responsible Provider.
If I register as a Home Clinic, does that mean that I am not eligible to claim a CDM tariff for any of my patients and that I must claim the CCM tariffs or nothing?
No. Once registered as a Home Clinic, you will have the option to choose between the CCM and the CDM tariff for each patient. Both tariffs are available to provide a transition period as clinics adopt the Home Clinic model and enrol patients. The intent of the CCM tariff is to ensure that the Most Responsible Provider is appropriately compensated for ensuring their enrolled patients are receiving comprehensive care including prevention, and recognizes the complexity in managing care for patients with more than one chronic condition.
Frequently Asked Questions: Clinics Working with and in Multi-Disciplinary Teams
We have been asked by clinicians to clarify some of the requirements within the CCM tariff as it relates to clinics with a multi-disciplinary teams. Specifically, clinicians had questions regarding 2 areas:
Ongoing communication with the patient, monitoring of patient condition(s) and the patient’s care plan, and
Ongoing coordination with other health care providers respecting management of patient condition(s) and the patient’s care plan.
What do we mean when we refer to a physician or member of his/her (primary care) team?
A primary care team is a group of professionals from different disciplines who communicate and work together in a formal arrangement to collectively care for a patient population in a primary care setting – whether in the same building or virtually. Examples of common primary care settings are family physicians’ offices or practices and community health centres. These teams often comprise but are not limited to: family physicians or general practitioners; nurse practitioners; other nurses; and other professionals, including dietitians, nutritionists, social workers, mental health counsellors, psychologists, pharmacists, exercise physiologists, physical therapists, and physician assistants.
What is required to claim the CCM tariff for patients seen by other members of the team at my clinic?
A Physician may claim the CCM Tariff for their Enrolled patient for whom they are indicated as the Most Responsible Provider and for whom the physician or a member of his/her team provided medical services consistent with the applicable indicators in the Manitoba Primary Care Quality Indicators Guide and documented these services in the EMR.
The primary care quality indicator services may be performed and documented by the physician or members of the physician’s team.
Co-location of clinicians and interprofessional providers that provide only episodic coverage and services to a patient would not be considered team-based care.
If the physician (MRP) did not make a claim for a primary care visit with the enrolled patient this year, will the CCM claim be rejected?
If the physician claiming the CCM tariff for a patient hasn’t had a successful claim for a primary care visit, the CCM claim will be initially rejected.
Physicians should query those rejected CCM claims and provide evidence of coordination and/or communication with members of the team having provided the patient ongoing comprehensive care during the preceding twelve (12) months.
Following are some examples of supporting documentation in the patient’s electronic medical record that could be used in a query for evidence of a physician who is engaging in teamwork, in order to demonstrate taking onus of a patient’s care:
Ongoing coordination with other health care providers respecting management of patient condition(s) and the patient’s care plan
This means that various clinicians are sharing clinical judgement and perspectives with one another to ensure the patient experiences optimal health outcomes. Examples of this clinical documentation could include, but are not limited to:
As per professional charting requirements, notations in the patient’s chart where clinical judgement was provided and/or direction noted by a member of the multidisciplinary team
Documentation of regular reviews of patient indicator reminders
Reviewing and providing feedback on a patient’s medical record
Documented communication (e.g. in person, electronic phone call, fax) with other providers or specialists to facilitate warm-hand-offs and/or informational continuity, such as care plans with noted care management responsibilities
Documented case-conferences to discuss and plan care
Ongoing communication with the patient, monitoring of patient condition(s) and the patient’s care plan.
This means various clinicians are corresponding with the patient (in and out of clinic visit) and/or, reviewing the patient care plan and means clinical judgement is being applied. Examples of this clinical documentation could include, but are not limited to:
As per professional charting requirements, notations in the patient’s chart where clinical judgement was provided and/or direction noted by a member of the multidisciplinary team
Scheduled in the medical record or EMR for follow-up consultation with another member of the multidisciplinary team
Care plan listing each provider’s role and responsibilities – could also indicate timing and responsibility of ordering/reviewing of tests
Documenting the handling post-visit questions and issues (e.g., quick conjoint or follow-up meeting, phone call to patient)
Documentation of the sharing of information, self-management support, community resources and organizations with patient (including to address social and environmental issues).
Depending upon the functionality in the EMR, this information may or may not be available in a way that is easily reportable for many patients at once. This information could be captured in the notes of the patient’s medical record, where the provider may have documented coordination of care or communication to the patient or other provider. In addition, some of these actions or providers roles could be captured in a patient care plan.