Payment Schedule Modernization

Medicine has changed significantly and fee-code descriptions have not kept pace with the evolution of modern practice. The SMA and the Ministry of Health are working together to modernize Saskatchewan’s payment schedule for insured services, to bring it in line with current medical practices. This is the first-ever comprehensive review of the Payment Schedule.

Payment Schedule Modernization (PSM) is cost neutral and provides an opportunity to:

  • Ensure fee-code descriptors align with current standards of medical practice
  • Clarify descriptors to reduce variation in billing practices, and;
  • Ensure fees accurately reflect the service provided.

The Process

PSM is a collaborative, multi-year process involving physicians, the SMA, and the Ministry of Health’s Medical Services Branch (MSB).

Physicians lead the process for building consensus and developing recommendations within each specialty section, with support from SMA staff. (Reimbursement is available for time worked on modernizing fee codes). Collaborative work also occurs between the Section and the Ministry. The project is guided by overarching principles: Patient-Centered Care, Appropriateness, and Fairness.

The process follows a structured, planned approach, working through the PSM decision-making process, and using timelines that align with existing  Payment Schedule Review Committee (PSRC) meetings (January and June).

Prioritization criteria for PSM include:

  • Frequently reviewed codes at the Joint Medical Professional Review Committee (JMPRC)
  • Frequently reviewed/rejected codes by the Medical Services Branch
  • Relativity/disparity (within and between sections)
  • Misalignment with PSM principles:
    • Patient-centered care
    • Appropriateness: 1) medically required and 2) value for money
    • Fairness
  • Unintended consequences from previously modernized codes

A committee of the Minister of Health (PSRC) reviews all proposed recommendations; the Minister has final approval on all modernization changes.

A section recommendation is ready for PSRC when:

  1. Codes are modernized in alignment with PSM principles;

  2. Savings and reinvestment are identified (cost neutral);

  3. Section members are informed and have opportunities to provide feedback; and

  4. The section executive builds consensus on a recommendation and receives support from MSB to forward the recommendation to PSRC.