New SOB update Dec 1, 2015

The Ministry of Health has released a new update to the Schedule of Benefits (SOB) as of Dec 1, 2015.  You can download the text file to update your billing software from here : Updated SOB 2015.

Launching billOHIP.ca at FMF 2015

Last week we attended the Family Medicine Forum at the Toronto metro convention center where we re-introduced Mo-Billing under its new name billOHIP.ca. While the app has been restructured, billOHIP.ca maintains the same underlying concept of being a communication tool between doctors and billing agents but can now also be used for do-it-yourself billing. The billing software is free and can be used to collect, store, share and submit billing claims. Several new features have been added to further streamline the billing process, making it more efficient for doctors and administrators. The feedback we received at FMF from doctors was very positive. As we now start to introduce billOHIP.ca to doctors we are very excited to hear feedback following the first couple weeks of using the app!

Hospital (service location) Number and Classification

When billing it is required that you specify the location at which the service was provided. You may notice that the each location has a 4-digit number associated with it as well as a 2-letter classification. It may be confusing if you see multiple listings for the same location, each with a different number/classification. The correct location can be chosen based on the classification. An example of some locations with number and classification are shown in the figure below.

The meaning of the different 2-letter classifications are given below and can also be found here on pg. 5.

TYPE CODE BROAD SERVICE CLASSIFICATION
AC Therapeutic Abortion Clinics
AL Alternate Payments Program
AM Ambulatory Care
AS Ambulance Services
AT Acute Care Treatment Hospital
CA Children's Aid Society
CC Correctional Centre
CM Children's Mental Health Centre
CO Community Health Centres
CR Chronic Care Treatment Hosp. and Units of Hosp. (Complex Continuing Care)
DM Domiciliary Care Treatment Unit of Hospital
DT Detoxification Centre
FP Family Planning Unit
GR Gen. Rehab. Hosp. and Units of Hosp.
HC Home Care Program (Community Care Access Centres)
HF Home for the Aged
HL Public Health Laboratory
HO Health Organization
HU Public Health Unit
IF Independent Facilities
IN Min. Of Health Internally Used Classification
LI Law Enforcement
LT Interim Long Term Care
MH Mental Health Unit
NH Nursing Home (Long Term Care Beds)
NS Nursing Station PR Approved Private Radiological Facilities
PS Provider Services
PT Physiotherapist (inc. Physiotherapy Centres)
RT Rehab. Treatment Centre (Children's Treatment Centre) SF Schedule I and II Facilities
SH Supportive Housing
SO Health Service Organization
SR Special Rehab. Hosp. & Units of Hospitals
SS Special Schools
TC Treatment Centre - Addiction (only for the Northern Health Travel Grant Program)
TH Telehealth
TM Temporary Long Term Care

Special Visit Premiums for ER and Inpatient Ward

We have previously blogged about special visit premiums, but there is always more to cover and it is good to have a reminder of how your special visit premium works. JCL Medical Systems, an OHIP billing company in the GTA has written the following blog on Special Visit Premiums for ER and Inpatient Ward. Make sure you pay close attention because JCL has great experience in OHIP billing and anything they share will be helpful to you!

Special Visit Premiums for ER and Inpatient Ward By JCL Medical Systems  

How often have you been called to see a patient in hospital after a long shift, and thought: “If only there were some sign of appreciation…”

Well there is. Special visit premiums (SVPs) are designed for those times when physicians are called unexpectedly to care for patients and – beyond a few limitations – add a generous boost to a doctor’s income. Although most doctors are aware of SVPs for evening and night shifts, many still don’t know that unique weekend/holiday SVPs are available, and with another long weekend approaching quickly, we thought we’d discuss them.

How to apply SVPs to hospital billing

Keeping it Simple: Whether or not to bill SVPs It’s why you’re seeing the patient that matters: if you’ve been called urgently or unexpectedly, it’s a Special Visit.  If it’s a scheduled or routine visit - even if it takes place in the evening or on a weekend – it’s not.

Special Visit Premiums can be confusing because of all the rules, restrictions, and limitations. First off, let’s define a special visit: a “visit initiated by a patient or an individual on behalf of the patient for the purpose of rendering a non-elective service”. This is from GP43 of the Schedule of Benefits.  Any unexpected visit to a patient on a holiday or weekend is eligible for a SVP, except if the visit is part of hospital rounds or if the visit would be considered routine. Further, if the physician is following up on his or her own patient at his or her discretion, no special visit has taken place and no SVP would be payable.

  

The MOH has two different categories of SVPs for weekends and holidays – one for the first patient a physician sees at the destination, and one for any additional patients the physician sees on that same trip. The MOH also has a travel premium that’s payable on the first patient seen when the physician travels to the hospital from outside of hospital grounds.  To complicate things further, the SVPs are different depending on where the patient is seen, for instance in the Emergency Department or on the Ward. See the chart below:

Weekend and Holiday SVPs	Emergency Department Patients	Hospital In-Patients
Travel Premium	K963- $36.40	C963 – $36.40
First Patient Seen	K998 – $75.00	C986 – $75.00
Additional Patient Seen	K999 – $75.00	C987 – $75.00

For weekends and holidays, SVPs have very generous maximums. Physicians are limited to a maximum of 20 SVPs per day and up to 6 travel premiums in the Emergency Department and the same maximums for SVPs and travel premiums on the ward. Remember too that if you see a patient between midnight and 7am on a weekend or holiday, the night time special visits and travel premiums should be billed as they are worth more.

Example: Billing Special Visit Premiums on Labour Day

Dr. G, one of our Internal Medicine Specialists, is on-call at her hospital on Labour Day.  At 8am, she gets called in to consult on a patient in the ED and travels from home. While there, Dr. G is asked to consult on two other ED patients and is then asked by staff to see two in-patients on the ward. After seeing these patients, Dr. G decides to round on two of her own patients that she’d been following all week as MRP. Here’s what she would bill:

Patient 1	8am -called in from home to ED	A135/K998/K963
Patient 2	8:45am – still in ED	A135/K999
Patient 3	9:25am – still in ED	A135/K999
Patient 4	10:00am – requested by nurse to see admitted patient	A133/C986 (no travel!)
Patient 5	10:24am – requested by doctor to see admitted patient	A135/C987
Patient 6	10:55am – rounds on her own patient	C132/E083 (no SVP!)
Patient 7	11:10am – rounds on her own patient	C132/E083 (no SVP!)

Note for Psychiatrists: When billing SVP’s, use A895 instead of A195.  It’s not only the rule, it’s worth more!

Dr. G now catches a break and heads home. At 2:20pm, she’s called back to the ED for a couple of new consultations, and the process starts again with a new first patient seen premium (K998) and a new travel premium (K963). What if Dr. G forgot to add a SVP for a patient? No problem – we always keep a sharp eye out for that sort of thing and would have corrected her billing already.

Final steps after residency

The CMA has some great resources to help residents transition from residency to practice, one of which describes the final steps in finishing residency and beginning practice. This blog aims to summarize the chapter.

Hospital Privileges
The accreditation committee of hospitals meet on a periodic basis- to avoid delays in obtaining hospital privileges, plan to have your application submitted before the meeting. The application requires several documentation such as medical license, malpractice insurance certificates and sometimes certificate of adult criminal conviction. Cost of the application can be $100-150.

Certification Exam
Residents are required to sit their respective certification examination in the final year of their training. Application to write the exam must be done one year in advance. After passing the exam, residents are then certified to practice in their respective specialty and are invited to become a fellow of the Royal College of Physicians and Surgeons/College of Family Physicians meber.

Maintenance of Certification (MOC)
To demonstrate commitment to continuing professional development and to provide evidence to competency physicians are required to complete a minimum of 40 credits by participating in continuing professional development activities and reporting their outcome. As a resident up to 75 credits obtaining for activities undertaken as a resident can be transferred. For family medicine physicians are required to participate in Maintenance of Proficiency where they must complete 250 Continued medical education (CME) credits over a 5 year cycle.

Province Licensure
Application to either Royal College of Physicians and Surgeons/College of Family Physicians of Canada in the respective province must be made before practicing. Application are reviewed as they are received and peak times are from March-July. Provincial medical association membership is also generally required to practice in the respective jurisdiction.

Malpractice Insurance
Upon graduation residents are required to arrange their own malpractice coverage such that the insurance is in force the date medical practice begins. These dues are often paid by the employer. In some cases MOH may pay for part of the dues or funding arrangements can be made to minimize disruption of cash flow.

Billing
A billing number is required in order to earn money for the services provided on a fee-for-service basis. Upon successful registration with the respective provincial College of Physicians and Surgeons, physicians are eligible for a billing number. Applying for a billing number from the MOH should be done in a timely manner to delay payment.


The full chapter can be found here: Final Steps.

The use of subsequent visit codes post-operatively

The Education and Prevention Committee (EPC) releases bulletins providing answers to OHIP billing questions posed by physicians. In Volume 5, No. 3 they discuss the use of subsequent visit codes post-operation. This blog briefly summarizes the main points from the bulletin.

1.  Surgeons are not eligible for billing C122 and C123 for post-operative subsequent visits, however C124 subsequent visit is eligible for payment on the day of discharge. General surgeon's may also be eligible for C032 for the first post-operative visit.

2. In cases where surgeons are rotating on call where the surgeon on call is to visit all other physician's patients, the on call physician is not eligible to bill C124. Only the operating surgeon (MRP) is eligible for payment of C124. As long as the operating surgeon fulfills all requirements for billing C124 within 48 hours of discharge he/she can bill C124 even if the visit on the day of discharge is from the on-call physician.

3. In cases where an acute care nurse practitioner dictates the discharge summary and signs on behalf of the MRP, the MRP is not eligible for payment of C124.

4. If a patient dies during the night C124 is not payable as a subsequent visit was not performed. A771 may be billed for certification of death.

Reference: https://www.oma.org/Resources/Documents/0503EPC_Bulletin.pdf

OHIP Billing: Palliative Care

The SOB defines palliative care as "care provided to a terminally ill patient in the final year of life where the decision has been made that there will be no aggressive treatment of the underlying disease and care is to be directed to maintaining the comfort of the patient until death occurs".

This blog will review billing codes commonly used for palliative care billing followed by an example.

1. Special palliative care consultation A945 ($144.75)

This is an assessment following a written request from a referring physician. A minimum of 50 minutes should be spent with the patient or their family.

2. Palliative care support K023 ($62.75 per 1/2 hour unit)

This is a time-based service for providing pain/symptom management, emotional support and counselling. This can be billed with A945 after exceeding the first 50 minutes of the consultation.

3. Counselling K015 ($62.75 per 1/2 hour unit)

This can be billed when counselling relatives on behalf of a terminally ill patient.

4. Telephone management of palliative care G511 ($17.75 per call)

This can only be billed when the phone call is requested by the patient or their caregiver, and the phone call should be documented and summarized. This cannot be billed on the same day as a consultation or assessment and can only be billed by the MRP (or substitute MRP). Max 2 times/week.

5. Palliative care case management fee G512 ($62.75)

This can be billed when providing supervision of a palliative care patient for a period of 1 week. This  includes monitoring their condition, discussion with the patient and their family, arrangements for assessments, procedures or therapy, etc. This can only be billed by the MRP and G511, K071 (acute home care supervision) and K072 (chronic home care supervision) cannot be billing during the same week as G512. In the event of a death during the week, G512 can still be billed.

6. Palliative care also has special visit and travel premiums as outlined in the SOB table below:

Palliative Care Billing Example

As the physician you just completed a house call on a palliative patient which lasted 1 hour, during the daytime on a weekday and are going to manage their palliative care for a week. You should bill the following:

A901 ($45.15) + K023 (2 units- $125.50) + B966 ($36.40) + B998 ($82.50)  + G512 ($62.75) = $352.30

where A901 is for a house call assessment that at minimum meets the requirements of an intermediate assessment.

References: http://www.health.gov.on.ca/english/providers/program/ohip/sob/physserv/sob_master11062015.pdf