Daily practice

Relations with the CPAM

The medico-administrative service platform (PFS-MDA)

The medico-administrative service platform is your central point of contact. It is positioned, in the department, as a “one-stop shop” for health professionals.

Accessible via a single call number: 3608.
Listening to you, throughout the different phases of your career: studies, internships, replacements, installation, activity, cessation, etc. on subjects relating to aid and contracts from the ARS and Health Insurance, in partnership with URSSAF, ARS, Orders, URPS, etc.
In your daily practice, the medico-administrative service platform provides you with practical answers: invoicing, payment, repository, conventional exercise, prevention, equipment, ordering printed materials, DMP, patient solicitation, patient file, nomenclatures, etc.

Health Insurance delegates - Délégués Assurance Maladie (DAM)

To help you in your professional practice, benefit from the help of the Health Insurance delegates (Délégués Assurance Maladie – DAM).

Find out what their role is and how they can help you.

What is the role of Health Insurance delegates?

Privileged interlocutors of health professionals, the Health Insurance delegates have the role of promoting the medicalized control of expenses by sharing useful information for your practice.

They also take over from the measures taken in favor of public health and develop professional cooperation promoting control of the healthcare system.

How do DAMs support you?

During peer-to-peer exchanges or visits by Health Insurance delegates (DAM), Health Insurance provides you with up-to-date information to facilitate your professional practice:

best practice recommendations from national health agencies
thematic inventory of practices in the territory or presentation of study results;
personalized information on the subject of the exchange to allow you to situate your practice with regard to that of your colleagues in the department or region;
practice support tools (good practice memos, decision tree, cost memos);
preview presentation of future communication campaigns aimed at policyholders;
brochures for patients so that they are better informed and more observant of your recommendations.

IT Services Advisors

The IT service advisors are your preferred contacts for online procedures and dematerialized documents. They provide you with information, take remote control of your computer station to assist you (in a secure connection), or even come to your office.

The IT services advisers are your preferred contacts for all questions relating to online procedures and dematerialized documents. They can help you with the following issues:

help with the computerization of the office;
advice on the use of invoicing tools and teleservices whether or not integrated into their business software;
training in the use of dematerialized services offered by Health Insurance;
technical assistance (starting the use of teleservices, incident resolution).

Teleservice – Penalty payment portal (PGARDE)

https://www.pgarde.ameli.fr

Dematerialization of Health Insurance on-call payment requests.

Doctors connect to PGARDE to control and request payment for on-call duty. The request for penalty payment is dematerialized. It is sent to the CPAM and paid within 5 working days.

Produced on the initiative of the CPAM of the Dordogne in 2008 then generalized on the French territory.

Participate in ongoing care

Doctor DENTIST PHARMACIST

What does outpatient care consist of ?

It corresponds to the response given to the unscheduled care needs of the population during the usual closing hours of private practices and health centres. It is organized:

every night from 8 pm to midnight.
Sundays and public holidays from 8 am to 8 pm.

Depending on the needs of the population, these hours can be modulated and in particular be extended to Saturdays from 12 noon as well as Mondays, Fridays and Saturdays called “bridges”.

How is it organised ?

The organization of the PDSA is based on medical regulation of calls provided by voluntary private doctors.

This regulation makes it possible to direct each caller towards the right medical service that his condition requires and, if necessary, to request an on-call doctor called an “effector”.

Who, can participate ?

Tout médecin libéral ou salarié peut participer au dispositif

Any liberal doctor or employee can participate in the system, as a regulator or as an effector. A retired doctor can also participate, on the double condition of having signed an agreement with the ARS, and of having been recognized by the National Council of the Order of Physicians (Conseil national de l’Ordre des Médecins -CNOM) for his ability to participate in the ongoing care, (permanence des soins ambulatoires – PDSA).

What are the terms of remuneration ?

Remuneration of the on-call doctor or effector

Childcare is remunerated on the basis of a lump sum, the amount of which may differ depending on the territory to take account of geographical constraints and the particular constraints of the exercise of childcare.

The amount of the flat rates is fixed by the regional specifications for the permanence of care.

This lump sum is collected by the on-call doctor, whether or not he has been asked during his on-call duty to carry out visits or consultations. To this flat rate, are added the fees relating to visits and consultations carried out during call duty at the request of medical regulation.

Remuneration of the regulating doctor

The private physician who participates in telephone medical regulation within the framework of the PDSA is remunerated on the basis of a fixed hourly rate, the amount of which is fixed by the regional specifications for the permanence of care.

What are the steps to take ?

The doctor who wishes to participate in this system must approach the association of permanent care or contact the Departmental Council of the Order of Doctors (CDOM) directly.

What are daycare and emergency services ?

A duty service for dental surgeons is organized in each department by the Departmental Council of the Order of Dental Surgeons and/or professional representative organisations, on Sundays and public holidays.

The participation of dental surgeons in the dental care permanence system is formalized by a nominative registration on the departmental duty table.

What are the terms of remuneration ?

on-call payment of €75 per half-day

To justify the payment of the on-call payment, the dental surgeon on duty undertakes to be available and reachable during the on-call hours in order to take care of the patient as soon as possible.

a specific increase for procedures up to €30.

This increase takes into account the mobilization of the technical platform.

What are daycare and emergency services ?

The on-call service is organized to respond during the day (Sundays and public holidays) to the needs of the public outside the opening days generally practiced by pharmacies.

The emergency service is organized to respond to urgent requests outside business hours. generally practiced by these pharmacies: every night from 9 p.m. to 8 a.m.

How are they organized ?

The organization of on-call and emergency services is regulated by the trade unions representing the profession in the department.

Failing agreement between them, or if the organization chosen does not meet public health needs, the Regional Health Agency (ARS) may, after consulting the aforementioned professional organizations and the Regional Council of the Order of Pharmacists, issue an order organizing the said services.

Barring specific exceptions, a pharmacist who opens his pharmacy during on-call or emergency duty, when he is not himself on duty, must keep it open throughout the service in question.

In all cases, local authorities are informed of the on-call and emergency services set up .

It is up to pharmacists who are not on call or emergency service to inform the public of the nearest on call or emergency pharmacy.

Who can participate ?

Participation in on-call and emergency services is a legal and ethical obligation for all pharmacists.

All pharmacies in an area are required to participate in these services, unless otherwise decided by the ARS, taken after consulting the organizations representing the profession in the department (circumstances or local particularities making it impracticable, or not necessary, to participation of all the pharmacies).

Generally ensured by the incumbent pharmacist, these missions can be delegated to an assistant pharmacist or a pharmacist replacing the pharmacy.

What are the terms of remuneration ?

On-call and emergency services are remunerated on the basis of an on-call allowance to which are added on-call fees collected by prescription.

The amounts of on-call and emergency allowances are defined within the framework of the national pharmaceutical agreement.

Find a substitute in case of replacement

Doctor Dentist Physiotherapist Nurse

What is the procedure ?

The replacement must request a replacement authorization from the Departmental Council of the College of Physicians on which you depend.

If the replacement is a student, the replacement request must be accompanied by the replacement license.

You must establish a replacement contract with your future replacement:

Application for replacement license
Model contract

Who can replace me in the context of a liberal exercise ?

The replacement can be a student or already a Doctor of Medicine and must be qualified in the same discipline as the replaced.

If the replacement is a student, he must hold a replacement license issued by the Council of the Order on which his faculty depends.

To obtain a replacement license, a student must prove that he is registered in the 3rd cycle of medical studies, that he has validated the number of semesters required in his specialty (certificate from the coordinator of the specialty).

If the replacement is a Doctor of Medicine, he must be registered on the Roll of the Order of Physicians.

What is the procedure ?

The replacement must request the delivery of a replacement authorization to the Departmental Council of the Order of Dental Surgeons (CDO) on which you depend.

You must establish a replacement contract with your future replacement. A model contract is available on the Council of the Order website.

Who can replace me in the context of a liberal exercise ?

Any dental surgeon registered on the roll of the Order or a dental surgery student fulfilling the legal conditions :

student in dental surgery having validated his 5th year and obtained his certificate of clinical and therapeutic synthesis,
or resident in dental surgery having validated his 5th year.

What is the procedure ?

The replacement must conclude a replacement contract with the masseur-physiotherapist, when the replacement exceeds 24 hours or if it is less than 24 hours and practiced on a regular basis.

The Order’s website offers a standard contract.

Who can replace me within the framework of a contracted liberal exercise ?

Any masseur-physiotherapist holding a state diploma, in the same specialization, regardless of status: liberal, private sector employee, public sector or civil servant, under certain conditions.

What is the procedure ?

The replacement must conclude a replacement contract with the nurse, when the replacement exceeds 24 hours or if it is less than 24 hours and performed on a regular basis.

The Order’s website offers a commented standard contract.

Who can replace me within the framework of a contracted liberal exercise?

Any nurse holding the State diploma of nurse, liberal, employee of the private sector, the public sector or civil servant, under certain conditions.