Blog/ Hospital billing
Special-hours rules for elective care
Understand the CBHPM’s regulatory distinction that rules out applying extra rates to scheduled procedures, since the thirty percent bonus is restricted exclusively to cases of immediate care and critical situations
- By
- Rivio, Editorial team
- Published
- Reading time
- 2 minutes
In the hospital billing ecosystem, correctly distinguishing between scheduled procedures and immediate interventions is one of the pillars of avoiding denials and ensuring regulatory compliance.
Many managers and auditors are still unsure about applying add-ons to physician fees for services performed outside business hours, especially when the service is not critical in nature.
Unlike what happens in situations of imminent risk, services scheduled in advance do not allow additional charges for special hours or weekends. Under the rules in force, this financial bonus is restricted to specific on‑call scenarios.
See the details of the CBHPM rule (2016 edition, item 2), which sets out the exclusive conditions for the industry:
2.1 Medical acts performed on an urgent or emergency basis will have a thirty percent (30%) add-on to their sizes in the following circumstances:
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2.1.1 In the period between 7 p.m. and 7 a.m. the following day.
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2.1.2 At any time on Saturdays, Sundays and holidays.
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2.1.3 For a medical act started during the normal period and completed during the urgency or emergency period, the 30% add-on applies when more than half of the procedure is performed during urgency or emergency hours.
Therefore, in routine billing, the absence of an urgent nature legally rules out increasing the amount, even if the procedure takes place on a holiday or at night.
