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.
Sunday, 10 January 2016
Saturday, 21 November 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!
Thursday, 15 October 2015
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
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
Wednesday, 30 September 2015
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
|
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.
Tuesday, 15 September 2015
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.
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.
Thursday, 27 August 2015
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
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
Wednesday, 15 July 2015
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
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
Tuesday, 30 June 2015
MC EDT- What is it and how do I register?
What is MC EDT?
Medical Claim Electronic Data Transfer, also known as MC EDT is an electronic service provided by The Ministry of Health and Long-Term Care (MOHLTC) which provides doctors with a secure method of transferring electronic claim files to and from the MOH. To access MC EDT all that is required is an internet connection as it is web based, allowing doctors to submit and retrieve their claim files seven days a week, 24 hours a day. Note however that there is weekly maintenance on Sunday mornings between 1:00-5:00 am and Wednesday mornings between 5:00-8:00 am at which time MC EDT is unavailable.
How to use MC EDT?
MC EDT can be accessed through a web page which provides a simple interface where doctors can upload and download claim files depending on whether they are submitting or retrieving their claim file. Note that, doctors still need a billing software to create their claim files for them as they must meet a specific format to be properly processed by the MOH. You have to pay for most billing software, however we are almost finished version 3 of Mo-Billing which will allow you to create your claim files for free!
How to register for MC EDT?
Before starting this process you should have a letter from the ministry providing you details for setting up you Go Secure account, such as your unique identifier.
1. To begin using MC EDT you must first register for a Go Secure account. To do so go to www.edt.health.gov.on.ca and select 'Register Now'.
2. After registration you should get an email from Go Secure, selecting the link in the email. You should now be at the login screen where you can enter your Go Secure ID (your email address) and the password you chose during registration.
3. After signing in you will be presented with the Email Validation screen, select 'here'. Follow the steps, where you will have to enter in information provided in your letter from the ministry.
4. Once you have completed step 3., go to www.edt.health.gov.on.ca and login using you Go Secure ID and password. At the Administration and MOHLTC Services screen you MC EDT enrolement should be complete and you can being using MC EDT to upload or download your claim files.
References: http://www.health.gov.on.ca/en/pro/publications/ohip/mcedt_mn.aspx
Medical Claim Electronic Data Transfer, also known as MC EDT is an electronic service provided by The Ministry of Health and Long-Term Care (MOHLTC) which provides doctors with a secure method of transferring electronic claim files to and from the MOH. To access MC EDT all that is required is an internet connection as it is web based, allowing doctors to submit and retrieve their claim files seven days a week, 24 hours a day. Note however that there is weekly maintenance on Sunday mornings between 1:00-5:00 am and Wednesday mornings between 5:00-8:00 am at which time MC EDT is unavailable.
How to use MC EDT?
MC EDT can be accessed through a web page which provides a simple interface where doctors can upload and download claim files depending on whether they are submitting or retrieving their claim file. Note that, doctors still need a billing software to create their claim files for them as they must meet a specific format to be properly processed by the MOH. You have to pay for most billing software, however we are almost finished version 3 of Mo-Billing which will allow you to create your claim files for free!
How to register for MC EDT?
Before starting this process you should have a letter from the ministry providing you details for setting up you Go Secure account, such as your unique identifier.
1. To begin using MC EDT you must first register for a Go Secure account. To do so go to www.edt.health.gov.on.ca and select 'Register Now'.
2. After registration you should get an email from Go Secure, selecting the link in the email. You should now be at the login screen where you can enter your Go Secure ID (your email address) and the password you chose during registration.
3. After signing in you will be presented with the Email Validation screen, select 'here'. Follow the steps, where you will have to enter in information provided in your letter from the ministry.
4. Once you have completed step 3., go to www.edt.health.gov.on.ca and login using you Go Secure ID and password. At the Administration and MOHLTC Services screen you MC EDT enrolement should be complete and you can being using MC EDT to upload or download your claim files.
References: http://www.health.gov.on.ca/en/pro/publications/ohip/mcedt_mn.aspx
Tuesday, 16 June 2015
House Calls: General information and billing
General information about house calls
A house call is a physician visit made to the patient in their own home. This may include anyone who can't or shouldn't come to the office to see the doctor for reasons such as disability, dementia (may forget their appointments) or VRE positive. House calls may last anywhere from 15 to 60 minutes depending on the complexity of the case. Patients should be treated as if they were in the office; for this it is important to be open and adaptable to the environment and ensure you pack the appropriate equipment. Some suggestions of what you need to take with you include:
• Hand sanitizer
• Flashlight
• Stethoscope
• Anaeroid BP monitor and selection of cuffs (pediatric, standard and large)
• Portable Otoscope and ophthalmoscope
• Tongue depressors
• Ear speculums and lighted ear curettes
• Tuning forks
• Bandage scissors
• Tape measure
• Gloves and lubricant
• Alcohol swabs, bandaids
• Urine bottles, C&S swabs and specimen bags
• Lab requisitions, X-ray requisitions, Prescription pad
• Dementia and depression screening tools (e.g. Montreal Cognitive Assessment, Geriatric
Depression Scale)
• Community DNR forms
• Medication flow sheets
• Patient chart (paper or laptop for EMR)
• Waterproof pads (for any procedure or exam that could dirty the patient’s furniture or bed, and to
put bag on)
Before conducting house calls it is important to consider your safety. You should be comfortable going to the patients home and should not feel concern to be surrounded by any of the other occupants of the home. Ensure to list your house calls on your day sheets or leave the addresses with someone at all times. Other cautionary notes include steering clear of any pets you may be uncomfortable with by simply asking the patient to put the pet in a separate room and avoid tag along bed bugs!
Reference: Caroline A Knight MD CCFP FCFP
House Call Billing Codes (OHIP Schedule of Benefits)
House call assessment: A house call assessment is a primary care service rendered in a patient’s home that satisfies, at a minimum, all of the requirements of an intermediate assessment.
A901 House call assessment............................................................................................ $45.15
Payment rules: A house call assessment is only eligible for payment for the first person seen during a single visit to the same location. Services rendered to additional patients seen during the same visit are payable at a lesser fee; i.e. bill as an in office assessment.
Complex house call assessment: A complex house call assessment is a primary care service rendered in a patient's home to a patient that is considered either a frail elderly patient or a housebound patient (defined below). The service provided must satisfy, at a minimum, all of the requirements of an intermediate assessment.
A900 Complex house call assessment ............................................................................. $45.15
Payment rules: A complex house call assessment is only eligible for payment for the first person seen during a single visit to the same location.
1. A frail elderly patient is defined as:
a. 65 years or older with one or more of the following age-related illness(es), condition(s) or presentation(s):
i. Complex medical management needs;
ii. Polypharmacy;
iii. Cognitive impairment (e.g. dementia or delirium);
iv. Age-related reduced mobility or falls; and/or
v. Unexplained functional decline not otherwise specified.
AND
b. resides in a home that includes:
i. The patient's home; or
ii. Assisted living or retirement residence (but does not include a long-term care home).
2. A housebound patient is defined as:
a. A person will be considered homebound where all the following criteria are met:
i. The person has difficulty in accessing office-based primary health care services because of medical, physical, cognitive, or psychosocial needs/conditions;
ii. Transportation and other strategies to remedy the access difficulties have been considered but are not available or not appropriate in the person's circumstances; and
iii. The person's care and support requirements can be effectively and appropriately delivered at home.
Medical record requirements: Complex house call assessment is not payable If the medical record does not:
1. Demonstrate that an intermediate assessment was rendered; and
2. Demonstrate that the patient was a frail elderly or housebound patient.
House call assessment - Pronouncement of death in the home: A house call assessment - Pronouncement of death in the home is the service rendered when a physician pronounces a patient dead in a home. This service includes completion of the death certificate and counselling of any relatives which may be rendered during the same visit.
A902 House call assessment - Pronouncement of death in the home.............................. 45.15
Claims submission instructions: Submit the claim using the diagnostic code for the underlying cause of death as recorded on the death certificate.
Special visits and travel premiums for house calls
Note:
1. The maximum number of services per physician per day for B960 is 2, for any combination of non-elective and elective visits.
2. The maximum number of services per physician per day for B990 is 10, for any combination of non-elective and elective visits.
3. Special visit to patient’s home premiums are only eligible for payment for first patient seen, regardless of number of patients seen during one visit to a home or to one or more living units in a multiple resident dwelling. A multiple resident dwelling is a single location that shares a common external building entrance or lobby e.g. apartment block, rest or retirement home, commercial hotel, motel or boarding house, university or boarding school residence, hostel, correctional facility or group home.
House call bonus
**PLUS 20% premium on value of claims for house call visits in excess of level C if at least 75% house calls are A900 (Complex house call).
Note:
1. No bonus or premium for FFS
2. FFS, CCM, FHG, FHN - house calls are OUT of basket (pay 100%)
3. FHO - A900, A901, and special visit premiums are IN basket (pays 15%), Travel premiums are OUT of basket (pay 100%). A902 (and all palliative care) is OUT of basket
Reference: OHIP Schedule of Benefits and Caroline A Knight MD CCFP FCFP
A house call is a physician visit made to the patient in their own home. This may include anyone who can't or shouldn't come to the office to see the doctor for reasons such as disability, dementia (may forget their appointments) or VRE positive. House calls may last anywhere from 15 to 60 minutes depending on the complexity of the case. Patients should be treated as if they were in the office; for this it is important to be open and adaptable to the environment and ensure you pack the appropriate equipment. Some suggestions of what you need to take with you include:
• Hand sanitizer
• Flashlight
• Stethoscope
• Anaeroid BP monitor and selection of cuffs (pediatric, standard and large)
• Portable Otoscope and ophthalmoscope
• Tongue depressors
• Ear speculums and lighted ear curettes
• Tuning forks
• Bandage scissors
• Tape measure
• Gloves and lubricant
• Alcohol swabs, bandaids
• Urine bottles, C&S swabs and specimen bags
• Lab requisitions, X-ray requisitions, Prescription pad
• Dementia and depression screening tools (e.g. Montreal Cognitive Assessment, Geriatric
Depression Scale)
• Community DNR forms
• Medication flow sheets
• Patient chart (paper or laptop for EMR)
• Waterproof pads (for any procedure or exam that could dirty the patient’s furniture or bed, and to
put bag on)
Before conducting house calls it is important to consider your safety. You should be comfortable going to the patients home and should not feel concern to be surrounded by any of the other occupants of the home. Ensure to list your house calls on your day sheets or leave the addresses with someone at all times. Other cautionary notes include steering clear of any pets you may be uncomfortable with by simply asking the patient to put the pet in a separate room and avoid tag along bed bugs!
Reference: Caroline A Knight MD CCFP FCFP
House Call Billing Codes (OHIP Schedule of Benefits)
House call assessment: A house call assessment is a primary care service rendered in a patient’s home that satisfies, at a minimum, all of the requirements of an intermediate assessment.
A901 House call assessment............................................................................................ $45.15
Payment rules: A house call assessment is only eligible for payment for the first person seen during a single visit to the same location. Services rendered to additional patients seen during the same visit are payable at a lesser fee; i.e. bill as an in office assessment.
Complex house call assessment: A complex house call assessment is a primary care service rendered in a patient's home to a patient that is considered either a frail elderly patient or a housebound patient (defined below). The service provided must satisfy, at a minimum, all of the requirements of an intermediate assessment.
A900 Complex house call assessment ............................................................................. $45.15
Payment rules: A complex house call assessment is only eligible for payment for the first person seen during a single visit to the same location.
1. A frail elderly patient is defined as:
a. 65 years or older with one or more of the following age-related illness(es), condition(s) or presentation(s):
i. Complex medical management needs;
ii. Polypharmacy;
iii. Cognitive impairment (e.g. dementia or delirium);
iv. Age-related reduced mobility or falls; and/or
v. Unexplained functional decline not otherwise specified.
AND
b. resides in a home that includes:
i. The patient's home; or
ii. Assisted living or retirement residence (but does not include a long-term care home).
2. A housebound patient is defined as:
a. A person will be considered homebound where all the following criteria are met:
i. The person has difficulty in accessing office-based primary health care services because of medical, physical, cognitive, or psychosocial needs/conditions;
ii. Transportation and other strategies to remedy the access difficulties have been considered but are not available or not appropriate in the person's circumstances; and
iii. The person's care and support requirements can be effectively and appropriately delivered at home.
Medical record requirements: Complex house call assessment is not payable If the medical record does not:
1. Demonstrate that an intermediate assessment was rendered; and
2. Demonstrate that the patient was a frail elderly or housebound patient.
House call assessment - Pronouncement of death in the home: A house call assessment - Pronouncement of death in the home is the service rendered when a physician pronounces a patient dead in a home. This service includes completion of the death certificate and counselling of any relatives which may be rendered during the same visit.
A902 House call assessment - Pronouncement of death in the home.............................. 45.15
Claims submission instructions: Submit the claim using the diagnostic code for the underlying cause of death as recorded on the death certificate.
Special visits and travel premiums for house calls
Note:
1. The maximum number of services per physician per day for B960 is 2, for any combination of non-elective and elective visits.
2. The maximum number of services per physician per day for B990 is 10, for any combination of non-elective and elective visits.
3. Special visit to patient’s home premiums are only eligible for payment for first patient seen, regardless of number of patients seen during one visit to a home or to one or more living units in a multiple resident dwelling. A multiple resident dwelling is a single location that shares a common external building entrance or lobby e.g. apartment block, rest or retirement home, commercial hotel, motel or boarding house, university or boarding school residence, hostel, correctional facility or group home.
House call bonus
**PLUS 20% premium on value of claims for house call visits in excess of level C if at least 75% house calls are A900 (Complex house call).
Note:
1. No bonus or premium for FFS
2. FFS, CCM, FHG, FHN - house calls are OUT of basket (pay 100%)
3. FHO - A900, A901, and special visit premiums are IN basket (pays 15%), Travel premiums are OUT of basket (pay 100%). A902 (and all palliative care) is OUT of basket
Reference: OHIP Schedule of Benefits and Caroline A Knight MD CCFP FCFP
Monday, 1 June 2015
Mo-Billing V3: MOH submission files and reconciliation
We have been working hard on producing the third version of Mo-Billing. The application is just about ready for beta testing. This new version has been completely re-designed to include an improved interface and an efficient workflow for both doctors and billing agents, either to use independently or together. Doctors can electronically submit directly to their billing agent using Mo-Billing so they can review the information, make corrections and submit it to the Ministry of Health (MOH). DIY doctors or billing agents may also use the application independently as a standalone billing software for submission to the MOH.
Several exciting new features have been added to V3, including but not limited to real-time tracking of compensation, auto-saving features, stored patient profiles, error detection, but most importantly the creation of submission files for the MOH and the ability to reconcile on Mo-Billing itself!
Get a sneak peak into V3 here!
What is next? Well, as of right now Mo-Billing does require users to use MC-EDT as our application creates MOH submission files which are then transferred through MC-EDT. We are beginning to work on incorporating submission directly to the MOH through Mo-Billing, no longer requiring the use of MC-EDT.
Keep your eyes peeled for V3 of Mo-Billing!
Several exciting new features have been added to V3, including but not limited to real-time tracking of compensation, auto-saving features, stored patient profiles, error detection, but most importantly the creation of submission files for the MOH and the ability to reconcile on Mo-Billing itself!
Get a sneak peak into V3 here!
What is next? Well, as of right now Mo-Billing does require users to use MC-EDT as our application creates MOH submission files which are then transferred through MC-EDT. We are beginning to work on incorporating submission directly to the MOH through Mo-Billing, no longer requiring the use of MC-EDT.
Keep your eyes peeled for V3 of Mo-Billing!
Tuesday, 23 December 2014
Series on Mo-Billing 2.0 Features: Messaging system
As we continue with our series on Mo-Billing 2.0 features, next we discuss the Mo-Billing messaging system. The messaging system is intended to allow the doctor and agent pair to simply communicate by sending messages attached to a claim through the application. With bank grade security all messages are secure to highest degree.
Often times doctors use email to ask questions or give directions to their billing agent, however with email's limited security, doctors are taking a risk in sharing patient information. With Mo-Billing, all information is encrypted and protected in a high security data center. Furthermore, there may be confusion in deciphering to which claim the doctor is referring to through email messaging so avoid emails that look like this:
Doctor: "Can you add A007 to J. A.'s claim?"
Billing Agent: "Which J. A.? On which admission? What date?"
Doctor: "Well I don't remember because I handed over all my billing record to you!"
Use Mo-Billing so your messages are attached directly to the claim you are referring to avoiding any confusion and delays, subsequently saving time.
Often times doctors use email to ask questions or give directions to their billing agent, however with email's limited security, doctors are taking a risk in sharing patient information. With Mo-Billing, all information is encrypted and protected in a high security data center. Furthermore, there may be confusion in deciphering to which claim the doctor is referring to through email messaging so avoid emails that look like this:
Doctor: "Can you add A007 to J. A.'s claim?"
Billing Agent: "Which J. A.? On which admission? What date?"
Doctor: "Well I don't remember because I handed over all my billing record to you!"
Use Mo-Billing so your messages are attached directly to the claim you are referring to avoiding any confusion and delays, subsequently saving time.
Sunday, 30 November 2014
Series on Mo-Billing 2.0 Features: 4 digit pin lock
We will be featuring a new series on our blog focused on Mo-Billing Version 2.0. With a transition from paper billing to electronic billing, many concerns have been raised as our current and future users venture into untouched territory. The goal of this series is to share and explain implemented features so that our users can be at ease as they transition to an automated billing process.
Considering that doctors use their mobile phone, tablet or PC at the hospital to capture billing data using Mo-Billing, one concern at the forefront of our their minds is the security and privacy of their patient's information within the heavily populated hospital. For this reason, we have implemented an automatically timed log out mechanism into the Mo-Billing application. Previously in version 1.0 every time users wanted to log back into the program they had to type their email and password, we received complaints that this was too cumbersome as they would log in to the program several times a day.
In our newest version of the app, we have implemented a 4 digit pin lock mechanism. This allows the user to easily log back into Mo-Billing several times throughout the day by typing a unique 4 digit pin. However, after 24 hours of inactivity the user is completely booted out of the system and will be required to enter in their email and password to gain access.
Implementing the 4 digit PIN allows our users to quickly access Mo-Billing throughout the day while still providing protection to their medical billing data, ensuring others cannot easily access their information if they get a glance or a hold of their mobile phone, tablet or PC.
Considering that doctors use their mobile phone, tablet or PC at the hospital to capture billing data using Mo-Billing, one concern at the forefront of our their minds is the security and privacy of their patient's information within the heavily populated hospital. For this reason, we have implemented an automatically timed log out mechanism into the Mo-Billing application. Previously in version 1.0 every time users wanted to log back into the program they had to type their email and password, we received complaints that this was too cumbersome as they would log in to the program several times a day.
In our newest version of the app, we have implemented a 4 digit pin lock mechanism. This allows the user to easily log back into Mo-Billing several times throughout the day by typing a unique 4 digit pin. However, after 24 hours of inactivity the user is completely booted out of the system and will be required to enter in their email and password to gain access.
Implementing the 4 digit PIN allows our users to quickly access Mo-Billing throughout the day while still providing protection to their medical billing data, ensuring others cannot easily access their information if they get a glance or a hold of their mobile phone, tablet or PC.
Thursday, 23 October 2014
Ending the silence: Version 2.0 of MO-BILLING
Dear Readers,
We sincerely apologize for the silence over the past 2 months- we have been hard at work in creating Version 2.0 of Mo-Billing. We are excited to launch the new version today in iTunes and Google Play stores. The new version can also be accessed via the web at jsapp.mo-billing.ca for doctors and jsapp.mo-billing.ca/admin for billing agents. The new version is more intelligent and has increased content for both the doctor and the billing agent.
For those of you unfamiliar with the application it automates the medical billing process for doctors and their billing agents. Doctors are able to electronically collect, store and deliver their claims and billing agents are able to electronically receive and store the claims. Soon Mo-Billing will have direct submission capability to the Ministry of Health. Below we share some screen shots of the new application.
DOCTORS
The Dashboard
Organize all your claims, in one location. The bottom tabs on the dashboard allow you to easily switch between your saved, submitted, rejected and paid claims.
Creating a claim
Have the added flexibility of creating claims for more than one specialty. In your profile specify which templates you want available to you when creating a claim. Then when you create a new claim you can choose which template to use.
Simply take a picture of the patient sticker to record their information. Fill in all other required fields, such as hospital, diagnosis and admission date. All your hospitals and diagnosis codes are pre-loaded into the app.
Enter the admission date, first seen and last seen date so Mo-Billing is able to automatically generate your service codes for you. After entering in the information change pages using the bottom tabs.
For consults, you can choose the type of consult, and indicate any special visit and travel premiums. Certain consults have time limitations- Mo-Billing will let you know if you met the time requirement for certain consults. Also, there are limitations to the number of premiums you can use- Mo-Billing tracks this for you so you know if you've reached a limit.
After entering the details, simply click generate to automatically generate your service codes. You can add or delete codes to certain days or add a new day all together.
Simplify communication. If you have any comments regarding the claim you can leave a comment for your billing agent. Likewise they can leave one for you.
BILLING AGENTS
The Dashboard
Organize all your doctors' claims in one location. For each doctor, keep track of which claims are submitted to the Ministry of Health, paid or rejected.
Viewing Claims
Find what you are looking for quickly. Choose the doctor of interest and the status of the claims you are interested in.
To view a claim click edit and see all the details you would normally receive on paper- right on your screen! Simplify communication. If you have any comments regarding the claim you can leave a comment for the doctor. Likewise they can leave one for you. Update the status of the claim so you and the doctor can keep track of everything.
That concludes the quick run through of the application. We are continuously working to improve and add content to Mo-Billing to better suit the needs of doctors and billing agents. We are currently working on implementing submission capability to the Ministry of Health. Billing agents will be able to simply review the the information on Mo-Billing and at a click of a button submit it to the Ministry of Health- data transfer to a third party billing software and the software all together will no longer be needed!
Please contact us at info@mo-billing.ca with any questions.
We sincerely apologize for the silence over the past 2 months- we have been hard at work in creating Version 2.0 of Mo-Billing. We are excited to launch the new version today in iTunes and Google Play stores. The new version can also be accessed via the web at jsapp.mo-billing.ca for doctors and jsapp.mo-billing.ca/admin for billing agents. The new version is more intelligent and has increased content for both the doctor and the billing agent.
For those of you unfamiliar with the application it automates the medical billing process for doctors and their billing agents. Doctors are able to electronically collect, store and deliver their claims and billing agents are able to electronically receive and store the claims. Soon Mo-Billing will have direct submission capability to the Ministry of Health. Below we share some screen shots of the new application.
DOCTORS
The Dashboard
Organize all your claims, in one location. The bottom tabs on the dashboard allow you to easily switch between your saved, submitted, rejected and paid claims.
Creating a claim
Have the added flexibility of creating claims for more than one specialty. In your profile specify which templates you want available to you when creating a claim. Then when you create a new claim you can choose which template to use.
Simply take a picture of the patient sticker to record their information. Fill in all other required fields, such as hospital, diagnosis and admission date. All your hospitals and diagnosis codes are pre-loaded into the app.
Enter the admission date, first seen and last seen date so Mo-Billing is able to automatically generate your service codes for you. After entering in the information change pages using the bottom tabs.
For consults, you can choose the type of consult, and indicate any special visit and travel premiums. Certain consults have time limitations- Mo-Billing will let you know if you met the time requirement for certain consults. Also, there are limitations to the number of premiums you can use- Mo-Billing tracks this for you so you know if you've reached a limit.
After entering the details, simply click generate to automatically generate your service codes. You can add or delete codes to certain days or add a new day all together.
Simplify communication. If you have any comments regarding the claim you can leave a comment for your billing agent. Likewise they can leave one for you.
BILLING AGENTS
The Dashboard
Organize all your doctors' claims in one location. For each doctor, keep track of which claims are submitted to the Ministry of Health, paid or rejected.
Viewing Claims
Find what you are looking for quickly. Choose the doctor of interest and the status of the claims you are interested in.
To view a claim click edit and see all the details you would normally receive on paper- right on your screen! Simplify communication. If you have any comments regarding the claim you can leave a comment for the doctor. Likewise they can leave one for you. Update the status of the claim so you and the doctor can keep track of everything.
That concludes the quick run through of the application. We are continuously working to improve and add content to Mo-Billing to better suit the needs of doctors and billing agents. We are currently working on implementing submission capability to the Ministry of Health. Billing agents will be able to simply review the the information on Mo-Billing and at a click of a button submit it to the Ministry of Health- data transfer to a third party billing software and the software all together will no longer be needed!
Please contact us at info@mo-billing.ca with any questions.
Wednesday, 30 July 2014
Guest Blogger: George Themelis
George Themelis will be our featured guest blogger this week. Any blog by George will be considered of great value as his billing company, GeoMed OHIP Billing Service, has a combination of over 25 years in the health care sector and over 30 years in general business management.The GeoMed team believes in exceptional customer service, worry-free submissions, and maximum claims revenue. George and his team achieve this by having systems in place to maximize their customer satisfaction and by looking after the physicians' needs first, ensuring daily submissions of OHIP claims and immediate follow up on rejections or errors.
Check out what George shares with us about:
For any medical billing inquiries you can find George's contact information on GeoMed's website: www.geomedbilling.com.
Monday, 23 June 2014
One advice for soon-to-be-graduate family docs
Many new family docs would work in a walk-in clinic before establishing more permanent pattern of work. If you are entertaining this kind of work, make sure you know how to give different kind of injections (IM, SC, Intradermal). It's one thing to know what kind of injections to order but another to actually be able to do it. Many walk-in clinics do not have nurses and the doc has to do it all. (Which also raises an important point that you should ask these things before signing up for the first shift. Do they have a nurse to help you? If they don't, do you feel comfortable to work in that kind of environment?)
Thursday, 19 June 2014
Post ICU billing
 |
| Content provided by Judy MacAlister |
Day 1 post ICU: C142 + E083
Day 2 post ICU: C143 + E083
Note that if you see the patient in the unit, you cannot bill these post ICU care codes.
To clarify let me share an example: The patient is admitted from the ICU to the ward today. Primary care is with the physician providing care in the unit for that day. You spend a little time with the patient in the unit before they are admitted to the ward and bill concurrent care. If you provided this care in the unit and billed C101 (patient seen on a visit to ICU, Pg. GP65 in SOB 2014) instead of concurrent care, then you are unable to bill C142 and C143. Bill concurrent care for the day of transfer only (do not bill the ICU code C101), then you are able to bill the C142 and C143 as applicable.
Monday, 2 June 2014
Billing for Hospital In-Patient Case Conference
 |
| Content by guest blogger Judy MacAlister |
The requirements of a case conference is; it must be a scheduled appointment; there must be at least 2 other participants in addition to the most responsible physician, this can include other physicians or regulated health professionals regarding a hospital in-patient. The outcome of the conference must be documented.
Wednesday, 28 May 2014
Watch How Mo-Billing Works
We recently finished our 'how-to' videos for Mo-Billing. Check them out!
Family Medicine
You can also watch how Mo-Billing works for:
Internal Medicine/Cardiology
Anesthesiology
Family Medicine
You can also watch how Mo-Billing works for:
Internal Medicine/Cardiology
Anesthesiology
Monday, 26 May 2014
Legal services for startups at a reduced cost
One of the most expensive costs to startups are the legal services they require from the moment of their inception and through all stages of their development as a company. Legal services do not come cheap and cannot be avoided for long in the startup realm. While these high costs are the reality startups must face, startups should we aware that there is funding from Law Firms which specifically help with the costs of legal services. We were fortunate to secure a spot within BLG's Growth Catalyst Program, which is further described in the copied article below from Techvibes. If you search diligently I am sure you can help secure some funding for your legal services!
Borden Ladner Gervais announced this week that it has selected startups Clear Pod and Figure of Eight, as the first companies to participate in the BLG Growth Catalyst Program.
Law Firm's Growth Program Boosts Tech Startups in Canada
Borden Ladner Gervais announced this week that it has selected startups Clear Pod and Figure of Eight, as the first companies to participate in the BLG Growth Catalyst Program.
The two companies are Ottawa-based and members of the Invest Ottawa GrindSpace XL accelerator.
Figure of Eight develops medical billing software permitting physicians to submit claims quickly, efficiently and securely. Clear Pod develops environmentally sustainable solutions for septic system waste water treatment that significantly improves the performance of septic systems.
The BLG Growth Catalyst Program is designed to offset legal fees by providing access to a multi-disciplinary team of tech-savvy lawyers, patent and trade-mark agents specializing in intellectual property protection, corporate, labour and employment law.
For companies who have attracted eligible government funding, BLG’s Growth Catalyst Program will match every dollar that those companies spend on legal services from BLG, up to $10,000 per company. This matching will be provided in the form of additional legal services.
“We are thrilled to offer these first stage Canadian companies access to affordable and high quality legal services without diluting the founders’ equity in the company,” said Curtis Behmann, partner, BLG Information Technology Group in Ottawa. “The BLG Growth Catalyst Program team are experienced legal professionals who provide both strategic and tactical advice to companies at a critical phase in their development.”
“As a startup company BLG has been generous in providing us with an opportunity to access legal services crucial in development of our company," said Suzan Bsat, co-founder of Figure of Eight.
Both companies recently graduated from the winter cohort for GrindSpaceXL. They were two of four GrindSpace companies that received government funding through the SPARC program via IRAP and Invest Ottawa. Pre-acceptance of the two companies into BLG’s Growth Catalyst Program assisted these companies in successfully obtaining the SPARC funding.
Friday, 23 May 2014
**Transferring Blog to Mo-Billing Website**
Our blog will be transferred over to our website. For future postings please visit: Mo-Billing Blog.
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