In this chapter:Here are 6 ways to improve your billing:
- Track Your Income
- Understanding OHIP Fee Premiums
- Telephone Consultations
- General Billing Tips to Avoid Rejections
- OHIP Billing Best Practices
1. Track Your IncomeToo many physicians outsource their billing to a third-party service that manually processes their claims. This may take away your billing headache but without 24/7 live reporting, your income becomes a black box. Your most common questions regarding billing, like:
- What's the status on my recent claims?
- Is there an issue with my patient's information?
- What claims are being rejected?
- What kind of OHIP premiums are available?
2. Understanding OHIP Fee PremiumsIt’s a good idea to understand and utilize OHIP fee premiums. Remember, you want to get paid properly for your services and premiums are a great way to maximize certain fee codes. When you enter a billing code we automatically display certain premiums that may apply you don’t forget. For example, if you bill a 00127 (Terminal Care Facility Visit) a notification pops up reminding you to bill the 13338 bonus for the first visit of the day. Most Commonly Used OHIP Fee Premiums: Here’s a quick list of the most commonly used OHIP fee premiums that are currently available.
OHIP Special Visit Premiums:
- Travel Premium,
- First Seen Patient, or
- Additional persons seen.
Billing Tip:Always Remember: Use the “A” Prefix In our experience, we’ve noticed that a lot of doctors mix up the prefix. For example, premiums need an “A prefix” and a visit fee. (C prefix codes are for non-urgent Inpatient visits and therefore no special visits apply). Be sure to use premiums that MATCH the SLI (service location indicator) on the claim.
The Chronic Disease OHIP Fee Premium
Anesthesia Age OHIP Fee Premiums
3. Telephone ConsultationsWe’ve noticed that most doctors don’t bill for telephone follow ups or consultations. The problem is that these can quickly add up to a pretty penny! By not billing for them, you’re essentially losing money. There’s a ton of activities you can bill for when it comes to managing a patient’s care. For example, any clinical discussion that takes place about a specific patient, is billable! These are known as physician to physician telephone consultations and pay up to $40.45 per call.
Telehealth Codes (and their OHIP Fee Premiums)!
4. General Billing Tips to Avoid RejectionsThere’s a handful of common mistakes that generally cause your OHIP claims to get rejected. To avoid payment delays keep the following in mind:
- Submission Errors
- Wrong use of SLI code
- There’s a fee code conflict - so assessment is required
- Invalid use of OHIP Premiums
- No Referring Physician
- Patient doesn’t have insurance
- Billing OHIP Special Visit Premiums on Counselling Codes
- Billing special visit premiums on counselling codes.***Counselling appointments are technically pre-booked and therefore no special visit premiums apply.
- Billing counselling (such as K013) on the same bill as an assessment with the same diagnosis code.***Counselling codes CAN be billed on the same day as an assessment BUT:
- They need to be on separate claims.
- They need to have different and unrelated diagnostic codes.
- Rejections due to Related Codes