Interpractice Care Agreement
The Funding Agreement only allows one fee to be billed for a client’s pregnancy, regardless of how many practice groups provided care to that client. The interpractice care agreement (ICA) is a predictable and equitable mechanism to split the billable course of care fees between two practice groups.
There are four versions of the ICA provided below. Two are for calculations that include the pay equity adjustments on billing fees ("ICA AFTER PAY EQUITY ADJUSTMENT") for 2017-2020 and 2020-2023. The other two ("ICA BEFORE PAY EQUITY ADJUSTMENT") are the former ICAs for calculations of fees prior to pay equity adjustments, provided here for MPGs to use as a reference to calculate the difference in fees that have already been paid out.
Download them here:
Completing the ICA
An ICA is typically used when two practices are eligible to bill for the same client. At times, practices will choose to enter an ICA where only one practice is eligible to bill; practice groups can determine on a case-by-case basis if the ICA should be applied.
When two practices have identified the need to complete an ICA, they will determine what method of calculation to use and which practice will bill. When determining which practice should bill, consider the following factors:
- Secondary care fee: Only the practice that has provided secondary care is able to invoice the secondary care fee.
- Travel disbursement: Travel disbursement is paid at the rate of the billing practice according to the Funding Agreement.
- Midwives’ experience level: The experience fee; retention incentive; experience fee rural and remote supplements; and operational fee supplements are paid according to the fee level and rural/urban/remote status of the billing practice.
- Rural and remote practices: The experience fee rural and remote supplement and the operational fee supplement are paid by the TPA based on the status of the billing practice.
- Caseload budget allocation: Is either practice short on allocated caseload such that they do not wish to bill for the client? Does either practice have an excess of caseload such that they want to bill?
Once it is determined which practice will bill, the practices enter into an ICA as follows:
- The billing practice group completes their portion of the ICA and sends it to the non-billing practice to complete their portion.
- Once both parties agree with the calculations, both practices sign the ICA and retain a copy. A signed copy is also sent to the AOM Benefits Trust (AOMBT).
- The billing midwife invoices the TPA and once payment is received, the billing practice sends a cheque to the non-billing midwife/practice and transfers the 20% benefits amount to the AOM Benefits Trust.
- The AOM Benefits Trust splits the benefits amount between the two midwives as indicated in the ICA.
The ICA Calculations
Through the formulas and questions posed, the ICA determines how to split the applicable fees as follows:
- The ICA determines what fees will be paid by the TPA based on the billing midwife and the care that was provided (e.g., is a secondary care fee payable).
- Based on how much work the practices completed and what the midwives and practices would have been paid under normal circumstances (e.g., fee levels, rural and remote supplements), the ICA calculates what the practices and midwives should have been paid.
- It then compares the amount of money that the billing practice will receive with the amount of money the billing and non-billing practice and midwife should receive. If the billing practice is set to receive more money, the surplus is evenly split between the practices. Similarly, if less money will be received, the deficit is evenly split between them.
- Finally, the ICA states how much money should be paid to each practice and how to split the benefits portion between the midwives.
Is the ICA that reflects the 2020–23 fee levels available?
On April 1st, the new Funding Agreement (PDF, 1.6 MB) with updated fee levels came into effect. However, the Interpractice Care Agreement (ICA) has not been updated to reflect the new fee levels, as the AOM has had to redirect resources to respond to COVID-19. In the meantime, midwifery practice groups (MPGs) looking to apportion payments for care being billed after April 1st can continue to use the 2019–20 fee levels. MPGs may choose to apportion the 1% increase manually or hold off until the ICA is updated at a later date.
We realize this is not ideal and apologize for the delay in having the updated ICA available as we prioritize work related to pandemic support.
Why are some sections in the ICA protected (locked for editing)?
Only cells requiring data entry are unlocked. This is to protect the integrity of the workbook and ensure users do not unintentionally alter the calculations, which can impact the division of monies for the billable course of care.
Does the billing practice group authorize the ICA once their portion is completed before the non-billing practice group completes their portion of the ICA?
The billing practice does not authorize the ICA until the non-billing practice has also completed their section and returned the completed ICA to the billing practice. Instead,
- The billing practice completes their section of the ICA (blue shaded areas only), then sends an electronic copy to non-billing practice.
- The non-billing practice reviews data entered by the billing practice, completes their section and authorizes the ICA. A copy of the ICA is sent to the billing practice along with the authorized page.
- The billing practice reviews the data entered by the non-billing practice and authorizes the ICA. A copy of the authorized page is sent to the non-billing practice for their reference.
- Both practice groups submit a copy of the authorized ICA to the AOMBT along with the ICA quarterly report.
Do both practice groups continue to send a copy of the authorized ICA to the AOMBT?
Yes, the AOMBT requests that both practice groups continue to submit a copy of the authorized ICA along with the ICA quarterly report. This is to ensure a copy is received in time to apportion the benefits payments (in case one practice forgets to submit the report). Any duplicate submissions are then omitted.
Can I use an electronic signature to authorize the ICA?
Yes, users have the option to either insert an electronic signature or print and sign a paper copy.
I’m using option 2 to complete the division of workload and the calculation doesn’t seem right. How can I correct it?
The ICA user cannot modify the calculations as this function is locked. Review the percentages entered for each midwife and ensure the entry is accurate. For example, if the non-billing midwife provided the entire care in the first trimester, enter 100% for “Initial care and/or 0-14 wks,” not 10%. If this does not resolve the issue, contact Feben Aseffa.
If a client has not received midwifery care prior to 15 weeks gestation, which practice group receives compensation for this care element?
If practice groups do not have a pre-agreed division of workload (option 1), they can select either option 2 or 3. Both options account for the added workload in initiating care. The care component, "Initial care &/or 0-14 wks" applies to initial care provided within or after 0-14 weeks. In the event that no value is entered in any one of the care elements, the ICA will gross up the percentage of workload to equal 100%.
Why is the secondary care fee (SCF) calculated into the ICA?
The SCF is included in the ICA calculation to ensure availability of funds to split between practice groups. It calculates what fees are available or billed and what fees would have been paid if there had been no ICA.
Why is the SCF value in the financial summary not equal to $214?
The ICA calculates the SCF, experience fee, on-call fee, and other applicable fees, including the operational fee. The surplus or deficit is calculated against these fees, to adjust for differences in fee levels and fees between the billing and non-billing midwife, resulting in either an increase or decrease in the amount allocated to each component of the ICA. This may result in SCF being more or less than the usual $214.
The surplus/deficit enables the backup to share in the benefits or losses of the calculation, such that neither all of the benefits nor losses are always assumed by the primary midwife.
How do I determine how much to pay the non-billing midwife?
Refer to the first tab in the ICA summary agreement, which outlines the "Total cheque to non-billing practice." This includes the total of all the fees and applicable incentives for the BCC (after the surplus or deficit has been accounted for). The 20% benefits amount is not calculated in the "Total cheque to non-billing practice" as this is transferred by the AOMBT into the midwife's account.