Rural Retention Premiums. The Agency agrees that the rates described in part B of this Appendix will be increased by the applicable Rural Retention Percentage Fee Premium for the community. In addition, the Agency will pay the Physicians the applicable Rural Retention Flat Premium for the community. EXHIBIT A TO APPENDIX 2 INVOICE FOR PAYMENT [TO BE DEVELOPED LOCALLY] FEE FOR SERVICE WAIVER AND THIRD PARTY BILLING ASSIGNMENT Physician Name/Incorporated Name MSP Practitioner Number If a professional medical corporation is signing this waiver and assignment, the term “I” will be read as referring to the professional medical corporation, and the professional medical corporation will ensure that the Physician Owner (as defined in the Contract) complies with this waiver and assignment. I acknowledge that the payments paid to me, or to [▼▼▼▼] as my authorized representative, by the Agency for the Services provided under the terms of the Contract between us dated [▼▼▼▼, 2020] are payments in full for the Services covered by this Contract and provided to the Agency and I will make no other claim for these Services. Waiver of fee for service xxxxxxxx in favour of the Agency. I will not retain and hereby waive, in favour of the Agency, any and all rights I have to receive any payments from the Medical Services Plan for fee for service xxxxxxxx for or in respect to any of the Services covered by this Contract. Assignment of all third party xxxxxxxx in favour of the Agency. I will use all best efforts and take all reasonable steps to maximize the recovery of third party xxxxxxxx for the Services covered by this Contract. With the exception of workers’ compensation xxxxxxxx, I will not retain and hereby assign to the Agency any and all rights I have to receive any payments for any of the Services from any third party including but not limited to:
Rural Retention Premiums. When a visiting physician provides services in a community that is eligible for Rural Retention Premiums, the visiting physician is entitled to the FFS retention premium in that community, but is not entitled for the flat sum retention amount, which is only for resident physicians. Visiting physicians must ensure the Rural Retention Program Service Clarification Code is on all FFS xxxxxxxx to receive the FFS premium. . Ministry of Health Services Subsidiary Agreement for Physicians in Rural Practice: Policy Manual Northern and Isolation Travel Chapter: Assistance Outreach Program Page: 3 of 4 (NITAOP)
