Holiday Office Coverage for Family Physicians, Q888, A888 and Q012/Q016

As the holidays are approaching, family physicians are reminded that the definition of “holiday” for A888 applies to all days during December 25-31, as per page GP3 of the Schedule of Benefits (December 1, 2022). Provided that all the criteria for A888 (Q888 for FHO) have been met, this year, as both Christmas and New Year’s both fall on a Sunday A888 (Q888 for FHO) can be billed December 23 to January 2, 2023 inclusive in addition to all regular weekend and holidays. After-hours services obligations for physicians in patient-enrolled models (CCM, FHG, FHN, FHO) are specified in the respective primary care contracts. During the holiday period, except for the recognized statutory holidays, Physicians in Patient Enrollment Models continue to be required to meet the service obligations. Due to Christmas Day and New Year’s Day falling on a Sunday, the statutory holidays are considered to be December 26, December 27, and January 2. Family Health Organization (FHO) Physicians As a reminder, the FHO contract requires that both scheduled and unscheduled appointments are to be made available during after-hours. The Q888 can be billed for rostered patients when at least 3 scheduled appointments have been offered. 

During December 23 – January 2 period, the Q888 (plus Q012) should be used for unscheduled rostered patients, the A007 (plus Q012) for scheduled rostered patients, and the A007 for non-rostered patients, or instead of the A007 the most appropriate fee code as per the Schedule of Benefits. Where the minimum required weekend after-hours blocks have already been met by the group, and further after-hours clinics can be provided, the A888 can be 2 billed if all other Schedule of Benefits requirements for that code are met.
Please see the OMA site dedicated to the Q888 (note you will need your OMA log-in and password to view the site). All Other physicians including FHN, FHG, CCM and FFS physicians. For those physicians in a FHN, FHG or CCM the Q888 is not an eligible code.
If the clinic is not scheduling appointments and operating as an emergency department equivalent, then the A888 can be billed with the Q012/Q016 added on for rostered patients. If the clinic is scheduling appointments, then regular Schedule of Benefit codes apply.

Summary:

A888: An emergency department equivalent - partial assessment is an assessment rendered in an emergency department equivalent on a Saturday, Sunday, or Holiday for the purpose of dealing with an emergency. $36.85. 

An “emergency department equivalent” is defined in the Schedule of Benefits as: an office or other place, including Urgent Care Centres, Walk-in Clinics, Extended Hours Clinics, or other settings (other than a hospital emergency department) in which the only insured services provided are to patients who do not have pre-arranged appointments.

To assist patients to find the appropriate care over the holidays, family physicians should provide patients with notification of hours of coverage, after-hours clinic locations, and telephone health advisory service numbers where applicable. This can be achieved for instance through answering machine messages or postings in the clinic.

If you have any questions, please contact the Ontario Medical Association at
info@oma.org.
Thank you,
OMA Economics, Policy and Research