OHIP Billing how-to: Hospitalist billing, as easy as pumpkin pie

Yesterday, I baked a pumpkin pie from scratch. It was very good. (Even the nurses agreed, so it has to be true). Yet I don't know why they say " it's as easy as pie". Making a pie isn't that hard, but I wouldn't say it's easy either.

Just like baking a pie, the hospitalist billing is not hard, but it takes some getting used to.

In a nutshell, this is what you do.

1. Hospital number

First you need to know what your hospital number is. Here is a government list of all the hospital numbers. If you are a big shot doctor working in a big shot hospital, you might have multiple numbers. Often times the hospital designated with the AT code is the one you want. (On page 5 there is an index for all the codes).

For example for The Ottawa Hospital, Civic site the choices are shown below:

 OTTAWA HOSPITAL ( THE )-CIVIC SITE AM 4079

 OTTAWA HOSPITAL ( THE )-CIVIC SITE AT 4046
 OTTAWA HOSPITAL ( THE )-CIVIC SITE MH 4546

You would most likely  choose 4046 since it is designated with the AT code. Our app will have a searchable list whereby simply typing in a keyword (Or even a few letters!) will give you the proper hospital number you are searching for.

2. Diagonsis code

Next you need the diagnosis, this is not any different from other billing. Again our app will have a searchable list.

3. Billing codes

You need to enter daily billing (fee) codes as per the following scheme:

Day of admission: C933A + E082A
"Day 1": C122A + E083A
"Day 2": C123A + E083A
Days in between: C002A (up to 5 weeks) + E083A
Discharge date: C124A + E083A

Here is the explanation: C933A - admission assessment. You were called down to admit this person. You have to do the whole history/physical and the dreaded dictation. Good for you! You get to bill this code (currently $79.90). E082A is a 30% premium you can apply to C933A for being the "most responsible physician (MRP)" for the patient that day.

C122A, C123A and C124A is for day 1, 2 and discharge, respectively. The government assumes that recently admitted patients as well as patients to be discharged require more attention from the physician so they will pay you more on these days (currently $58.80). E083A is a 30% premium that can be used for all days other than the admission day.

Finally, C002A (currently $31.00) is used for the days in between "Day 2" and the discharge day. You are a smart doctor, you have figured it all out and the time spent between "Day 2" and the discharge date is simply waiting time while the patient gets better. Well... most of the time at least. Again don't forget the E083A premium code with the C002A codes.

For those interested, Mo-Billing App actually provides an electronic platform where you can collect, store, deliver (to your billing agent) and retrieve all your billing information. You can simply create claims on the go and have most of your fee codes auto-generated for you.

On the app, all hospitals and diagnoses are searchable so you don't have to worry about memorizing any codes. Furthermore, to save time you can take a picture of the patient sticker rather than typing out the patient information. We have also implemented a feature that will auto-generate your most common fee codes for you given you enter the admission date, the first day you saw the patient and the last day you saw the patient. Read more about the app at www.mo-billing.ca. Or you can create an account for free at http://app.mo-billing.ca.

A real example

Patient Joe Smith was seen at the lovely Civic Hospital for pancreatitis (a little excess with the holiday "spirit"!).  Showed to the ER on Dec 28, admitted Dec 29 and discharged Jan 3rd. The following is the complete set of info one needs to bill for this admission:

Patient name: Joe Smith
DOB: 5-5-1955
OHIP:###########ZZ
Admission date: Dec 29, 2013

Hospital code 4046
Diagnosis code 577

Dec 28: we don't care what ER docs do :), your billing starts on Dec 29.
Dec 29: C933A + E082A
Dec 30: C122A + E083A
Dec 31: C123A + E083A
Jan 1: C002A + E083A
Jan 2: C002A + E083A
Jan 3: C124A + E083A

Enter this information into your favourite billing program or give it to your billing agent.

Stay tuned as we will be posting the billing practice to use in more complicated, yet common, scenarios.