Everything you submit to AHCIP doesn’t always come back paid. Even when it does, you might still be under billing or missing out on certain premiums. Throughout 2019 our billing agents complied 7 AHCIP tips and reminders to make sure you’re avoiding rejections while still getting paid properly for everything you do.
We’ve recapped those 7 tips below so you can double-check that you’re not making simple mistakes or forgetting to bill for something you’re already doing anyways!
Let’s dive in:
1. Utilize 03.05JR
When going through claims our billing agents noticed a lot of doctors aren’t using 03.05JR at all, even though it adds up quickly and can be quite lucrative. If you don’t recognize it, 03.05JR is used for any phone call that’s made to a patient (not including voicemails).
03.05JR pays $20 and you can use up to 14 times per week. You can claim it in addition to other visits and services for that patient, on the same day.
Use 03.05JR anytime you speak with:
the parent or guardian of a pediatric patient,
the primary caregiver of a patient with mental health concerns, or
an agent (someone who has been appointed to make personal decisions on your patient’s behalf).
You can claim a maximum of 14 telephone calls per week.
You need to document any communication in your patient’s record/chart.
You can only claim 03.05JR if you’ve initiated the call.
You can claim it in addition to other visits and services provided on the same day (see billing tip below for more information).
You cannot claim it for management of patient’s anticoagulant therapy (bill that under 03.01N).
If you bill 03.05JR then you aren’t eligible for 03.01S or 03.01T within the same week.
AHCIP requires different encounter numbers for 03.05JR and a visit when they are provided on the same date of service.
For example, if you are providing both services on the same, you would add a separate encounter number for the visit (encounter 1) and the 03.05JR (encounter 2). This is an exception since phone calls do not ordinarily need an encounter number.
2. Prevent Submission Errors
Submission errors are going to happen, especially if you’re billing in high volumes, because let’s face it; everyone makes mistakes. Although getting an error is not the end of the world, it will delay your pay. Here are some common scenarios to watch out for:
Location of fee code doesn’t match. Ie, radiologic fee code performed in ER.
There’s a fee code conflict – so assessment is required.
Invalid use of Premiums.
No Referring Physician.
Patient doesn’t have insurance.
Extra Reminder: In our experience, most submission errors are a direct result of either not adding a referring physician OR not double checking that your patient has insurance. Make sure you always check these two things before submitting a claim.
3. Remember to use the ‘CMGP’ Modifier
The complex modifier (CMGP) compensates you for a number of services that are not “face-to-face,” such as:
Writing a referral letter
Reviewing the chart.
Reviewing (but not waiting for) lab/DI results.
Talking with and examining the patient.
***Basically, anything you do in relation to your patient’s care.
The catch? You must complete these activities on the same date of service the patient was seen:
Reminder: If CMGP is eligible, it will show up under ‘Fee Modifier’ once you’ve entered in a fee code. You cannot use it for anything that takes less than 15 minutes.
4. Use the After-hours Time Premium (03.01AA) Correctly
Don’t forget to add the After-hours time premium (03.01AA) if you’re working late, on weekends or during the holidays. 03.01AA is a time-based premium, based on 15 minute units. It uses a modifier to indicate the time of day and how many 15 minute units it took.
You need to make sure you match your modifier description and time units exactly, otherwise your claim will get rejected. On the Dr. Bill app all you need to do is enter your start and end times and the modifier codes will calculate automatically based on those times.
5. Multiple Injections
Remember, if you’re giving multiple injections on the same encounter, you only need to submit one claim and change the number of units to reflect how many injections you’ve given. If you’ve submitted more than two calls of injections, then in the notes section state which injections you’ve provided.
Tip: If the nurse gives a flu or pneumonia vaccination you can still bill for it using HSC 13.59A. All other injections for HSC 13.59A must be provided by yourself.
For a complete guide on how to submit claims for refurbishment in Alberta check out our Alberta Health Billing Guide.
6. CMGP Complexity Modifiers
(CMXV15, CMXV20, CMXV30, CMXV35, CMXC30)
You can use complexity modifiers for the total time you spend managing your patient’s care. Keep in mind you have to use them on the same day your patient was seen. For example:
You review your patient’s chart, see your patient and then complete a referral letter. The total time spent is 35 minutes. Therefore, along with the visit fee code, you could use CMXV35.
However, if you were to complete the referral letter on a different day than the visit and it took you 10 minutes to complete, you would not be able to include it in the modifier. Therefore, the total time spent would be 25 minutes. You’d need to use CMXV20 ‘for 20 minutes or longer.’
7. Know how to Handle Error Codes and Rejections
Shortly after the cut-off date, the ministry of health releases Remittance Advice (RA) reports and Error code reports. These reports outline which claims have been paid, paid with adjustment, or rejected.
You should be able to access your reports through the billing service you’re using, as generally they’re integrated with your AHCIP’s web service. For example, if you’re billing with Dr. Bill you’ll have the option to see the current status of all your active claims at any given time. You can:
easily see the status of each claim,
see a list of refusals,
see a list of rejected claims, and
see which claims have been paid/paid with adjustment.
Keep in mind though, that these reports are live so numbers will always change depending on whether claims are being resubmitted or released.
Alberta Health Billing Explanatory Codes
If you do get an error, it will be accompanied by a code, and a description explaining what that code means. Use our searchable database to find out the description of your explanatory code:
While sometimes medical billing might be overwhelming, it no longer is as time-consuming or confusing as it used to be all thanks to automated services and mobile billing. Nowadays it’s more of a learning curve than anything else.
Our final reminder is to make sure you get into the habit of tracking your income so you don’t forget to resubmit rejections and learn from past billing mistakes. This will ensure you’re getting paid properly for all of the work that you do and you aren’t missing out on lost income.
Of course, if you’re billing with Dr. Bill then remember that we handle all rejections and resubmit them automatically for you.
As always, if you have a question about any of our 2019 billing tips, or even something that wasn’t covered her, reach out to our billing team and we’ll be happy to help.
This article offers general information only and is not intended as legal, financial or other professional advice. A professional advisor should be consulted regarding your specific situation. While information presented is believed to be factual and current, its accuracy is not guaranteed and it should not be regarded as a complete analysis of the subjects discussed. All expressions of opinion reflect the judgment of the author(s) as of the date of publication and are subject to change. No endorsement of any third parties or their advice, opinions, information, products or services is expressly given or implied by RBC Ventures Inc. or its affiliates.