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Fee Code Program Registration

Note

  • If you have questions as you complete the registration form, please refer to supporting resources.
  • After you submit your completed registration form, our program staff will notify you when you can start billing. Please note this could take up to 10 business days.

Please Check the Statements That Apply to You

Participation in the Program is subject to eligibility requirements, AS REFLECTED IN QUESTIONS 1 THROUGH 4 BELOW.

To participate in the Program, you (the Fee-For-Service Family Physician):

1.

2.

3.

Note: Checking a box in #4 means, you currently perform the service at the stated level OR you can demonstrate a clear and consistent pattern, which, if continued, would meet the requirement(s) of the stated service level(s).

Example: You are new to practice and although you regularly provide after hours care and regularly conduct medical care visits to your own patients in their personal residences, you do not meet the annual requirement as stated in the criteria as you have only been in practice for 3 months. Are you eligible for registration?

Yes, if you can demonstrate a clear and consistent pattern, which, if continued, would meet the requirement of the stated service level, you are eligible to participate in the Program.

Remember: If you answered NO in #3, you must meet at least (6) of the following requirements.

Remember: If you answered YES in #3, you must meet at least (4) of the following requirements.

Important Notes:

  • The information you provided above will be validated by program staff through both physician-provided and MCP data, and you will be contacted over the next several weeks as part of that process. Your ability to bill will not be impacted while the validation process is occurring.
  • In relation to #3 above, if, at the time the EMR process is to be initiated, you decide to withdraw, you are required to meet six (6) of the requirements in #4 above. Please contact FPRP to complete a revised registration form.
  • If you currently do not meet Fee Code Program eligibility requirements and would like to discuss this further, please contact a member of the Family Practice Renewal team.
  • On an ongoing basis, reviews, random or otherwise, will be conducted to verify continuing physician compliance with eligibility criteria. Wherever possible, FPRP will support efforts to achieve compliance.
  • Where, at any time and in the sole discretion of the FPRP, it is determined that a physician is not compliant with the eligibility requirements of the Program and there is no reasonable prospect of the physician achieving such compliance, the FPRP may deny or revoke, as the case may be, a physician’s participation in the Program.

Terms and Conditions of Registration

Your registration in the Fee Code Program (“Program”) is subject to the terms and conditions of the agreement below (“Agreement”). To accept the terms and conditions, to be bound by them and to be eligible for registration in the Program, you must read and accept this Agreement. To accept, click on the “I agree” box below.

  1. Entire Agreement – The above Fee Code Program Registration Form (“Form”) is incorporated as part of this Agreement. This Agreement represents the entire understanding between the parties with respect to its subject matter.
  2. Validation of Eligibility Requirements – I understand that FPRP requires information from MCP about the health care I provide (“Information”) for validation of eligibility requirements stated in the Form.
  3. Failure to Meet Eligibility Requirements – I acknowledge that failure to meet or maintain eligibility requirements at any time will result in denial, suspension or termination of registration in the Program.
  4. MCP – I understand that MCP is subject to the Medical Care and Hospital Insurance Act, Access to Information and Protection of Privacy Act (ATIPPA) and the Personal Health Information Protection Act (“Legislation”).
  5. NLMA Privacy Policy – I understand that FPRP abides by the NLMA Privacy Policy, and as such, any information collected will be limited to that which is reasonably necessary for the purpose stated. I understand FPRP will hold personal information in confidence and will not use, disclose or retain information for purposes other than those stated, except with express physician consent.
  6. Disclosure to Third Parties – I understand that FPRP may disclose personal information (i.e. criteria- related activities in requirement 3, Program Eligibility) to third parties (i.e. external firm contracted to conduct eligibility compliance) that are not FPRP-affiliated if those third parties have contracted with FPRP to assist in providing products and services. In such circumstances, FPRP will take reasonable contractual measures to ensure that personal information is protected by those third parties at a level comparable to the requirements of ATIPPA.
  7. Consent Required – I understand that the disclosure to and the use of the Information by FPRP is necessary to participate in the Program. Should I choose not to provide consent for disclosure to FPRP of the Information I will not be eligible to participate in the Program.
  8. Consent Given – I hereby consent to MCP providing FPRP with the Information in accordance with the Legislation.
  9. Consent Revoked – I acknowledge my participation in the Program is voluntary and I may revoke my consent, and my participation, at any time, by completing the ‘Revocation of Registration and Consent’ Form and submitting it to FPRP.
  10. Changes in Program – I understand the design of the Program may be altered over time, including the conditions and fees associated with each code. I understand that in such circumstances, physicians will be notified and have the opportunity to withdraw their consent and participation by completing the ‘Revocation of Registration and Consent’ Form.
  11. Information True and Accurate – I confirm that I have read and understand the terms and conditions above and that the information that I have provided in the Form is true and accurate.