Chapter 4:
Maximize Your Billing Potential

10-minute read
Did you know that the average physician in Canada fails to bill for at least 5% of the insured services they provide? This translates to roughly $24,000 per year (or $480,000 over 20 years)! While Chapter 3 covered everything you need to know to start mobile billing, now let’s dig deeper into how you can maximize your billing potential by using automation and OHIP fee premiums to make sure you’re getting paid properly for the services you provide.

In this chapter:

Here are 6 ways to improve your billing:
  1. Track Your Income
  2. Understanding OHIP Fee Premiums
  3. Telephone Consultations
  4. General Billing Tips to Avoid Rejections
  5. OHIP Billing Best Practices

1. Track Your Income

Too 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?
These questions will go unanswered. It’s really important to make sure you know how much money is coming in, and how much money is going out. As briefly mentioned in chapter 1, Dr. Bill allows you to actively control and manage your income as you can keep track of your earnings and remittance reports. These reports are live so numbers always change depending on whether claims are being resubmitted or released. No matter what subscription plan you’re on you’ll be able to easily identify where you’re money is:

2. Understanding OHIP Fee Premiums

It’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:

Special visit premiums can be applied to any non-elective (urgent and emergent) consults and assessments. They are used in 3 different situations:
  1. Travel Premium,
  2. First Seen Patient, or
  3. Additional persons seen.
The actual $ amount changes depending on the time of day (there are 5 different time options for special visit premiums).

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

This OHIP premium is for anyone who works with chronic disease, as it typically requires more follow ups. It’s a percentage-based premium (which adds an extra 50% onto the fee code) and is payable on certain out-patient assessments.For example, let’s say you bill A263 (Medical Specific Assessment) which is $77.70. By adding E078, you’ll get an extra 50%, which will bring the entire assessment to $116.55 (meaning the premium added an extra $38.85). For more information see this article on how it works and how to bill it quickly using Dr. Bill.
  • Anesthesia Age OHIP Fee Premiums

The Anesthesia age OHIP premium is for physicians who are providing anaesthesia services, which allows them to claim additional units based on certain patient characteristics. There are 5 different fee codes with different $ amounts, however the extra units will be calculated and paid automatically. You only need to manually add the premium If your patient is a premature newborn.

3. Telephone Consultations

We’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)!

Telehealth services are health services provided over live video instead of in-person. They can be particularly useful if you live or work with patients in remote places. They also reduce travel time, wait time and scheduling conflicts. However, in order to benefit from telehealth codes, you need to register with OTN, the government-funded non-profit that was created to expand the use of telemedicine across Ontario. It works like this: You submit telehealth codes to OHIP, OHIP pays you and then OHIP gets reimbursed through OTN. There are 6 premium telehealth codes that are available when providing telemedicine services. Just remember, when submitting telehealth codes your location needs to be set to ‘Ontario Telemedicine Network.

4. General Billing Tips to Avoid Rejections

There’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
Submission errors are claims that have not passed the pre-edit approval process by OHIP. You’re likely to get a few submission errors, because let’s be honest nobodies perfect, and mistakes are going to happen, especially if you're billing in high volumes.Here are some common scenarios to watch out for:
  • 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
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. So, make sure you always check those two things before submitting a claim. If you do get a submission error, it will be accompanied by an OHIP Billing Error code that OHIP uses to explain what the problem is.
  • Billing OHIP Special Visit Premiums on Counselling Codes
We notice a lot of counselling codes getting rejected. This is usually due to:
  1. Billing special visit premiums on counselling codes.***Counselling appointments are technically pre-booked and therefore no special visit premiums apply.
  2. 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.
👉  While there are certain exceptions to this, no other services are eligible for payment on the same day as any type of counselling service.
  • Rejections due to Related Codes
We often notice there's a number of rejections due to related codes being billed on separate claims. If it's related, it must be billed on the same claim. For example, if you bill a consultation, on the same bill you need to add your special visit codes.

5. OHIP Billing Best Practices

In order to maximize billing there are a few tips we suggest every physician follows. This section is about best practices and what will be most effective for your business in the long run.

1. Submit Claims within 6 Months

Submitting your claims to OHIP on time is very important to ensure you get paid for the services you provide (on time)! OHIP pays six months to date of service but only accepts RAI’s (Remittance Advice Inquiry) within 3 months.

2. Bill Daily

The best thing you can do is to treat billing as if it were part of patient care and bill directly right after you see a patient. This is extremely beneficial as the information will be fresh in your mind and you’ll get into the habit of never forgetting to bill. If it’s not realistic to bill directly afterwards then schedule in a specific time to do your billing so it doesn’t pile up.

3. Earn More & Save Time

In addition to best practices and the previous tips we’ve mentioned above, there are three key things that have proven to help our users:

A. Rejection Management

We’ve already mentioned rejection management once, but it’s worth bringing up again. If you’re on a plan that offers rejection management our billing agents will correct and resubmit any rejected billings for you. Our software automatically picks up most refused claims and resubmits them. If we need more information, we’ll notify you. This has not only saved our doctors time, but has led to recovered funds for 10,500 claims!

B. Mobile Billing

Billing on your smartphone helps you automate submissions and gives you quick and easy solutions to bill faster. Systems like ours are built on a database of Ontario billing codes, making it easy to look up and apply the correct one. This saves you time and reduces the likelihood of a claim getting rejected. The majority of our users’ report saving at least 5-10 hours a month. So, instead of spending weeknights and weekends finishing paperwork, add a claim in 30 seconds and get on with your day; it’s as simple as taking a picture.

C. OHIP Billing Experts

We understand that billing is a learnt skill and something that isn’t taught in Med school. While billing yourself allows you to be in control of your income and make sure you’re billing for everything you do, having access to a billing expert will reduce your rejection rate, helping you save time and money. Most subscription plans give you access to our billing agents. Have a question? Need us to fix a problem? Don’t worry, carry on with your day while we investigate and find the solution for you.
Chapter 5: Cheat Sheets by Specialty

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