On March 27, 2014, Mo-Billing was featured in Technology for Doctors, Volume 5, No. 6. Technology for Doctors is a bi-monthly report on key health IT news for physicians. Visit Technology for Doctors and read the article on Mo-Billing presented as an administrative solution.
Saturday, 29 March 2014
Tuesday, 25 March 2014
ER OHIP billing
Here is a simple introduction to ER billing in Ontario.
First let's start with the weekdays
Weekday (8am-5pm)
H101 Minor (14.70)
H102 Comprehensive (36.45)
H103 Multi-system (29.65)
H104 Reassessment (14.70)
For every patient you see, you can use one of these codes. As usual for the ministry there is precious little to guide us what these words really mean. Also peculiar to this system is that there is no "single-system" assessment. So the usual dilemma is when you see a "single-system" disease that is not "minor". So here is my very personal interpretation of these words.
"Minor" assessment applies to very simple service such as refilling a few days worth of anti-hypertensive while the family doctor is away for the weekend. Patient is CTAS 5, there are no acute complaints. Or a patient is referred to ER to insert an IV or a Foley catheter from a family doctor's office. No further assessment is necessary other than your order on the chart. Patient returns to the family doctor's office promptly.
Anything beyond this is "multi-system" more or less. For example, if a person comes in with a cold, you are examining both the lungs and heart. Hopefully you are also checking the head and neck. Maybe an x-ray? Some quick blood work if you are worried about mono? That is multi-system to me.
The next step up is "comprehensive". If you are taking a full history (including family history, social history, systems review) and doing a "full physicial", according to your own definition, then your case is likely comprehensive. An elderly person comes in with pneumonia, has difficulty coping at home, there is some difficult family dynamics, and you are giving fluid and IV antibiotics. This is not a typical "walk-in" type of patient, but rather more of "obs" case as many ERs call them, where you are seeing them over multiple hours to check on the response to the treatment or interpret the on-going diagnostic tests. Personally, I should use this code more often...
"Reassessment" can be used 2 hours after the last assessment. However, you cannot use it if this "reassessment" leads to discharge or a referral. (i.e. a discharge assessment is NOT a "reassessment"!) You can only use 2 "reassessments" per patient per day, and maximum 3 per day between multiple physicians if the patient was already seen by another ER physician. Again, I should use this a bit more often.
Please refer to page A11 in the Schedule of Benefit published by Ontario Ministry of Health for actual wording from the ministry. Yes, it is not clear and yes, it is open to interpretation.
Once you have understood the weekday codes, the rest is easy.
Weekday evenings (5pm - midnight) are coded as H13_.
H131 Minor (16.15)
H132 Comprehensive (40.10)
H133 Multi-system (32.65)
H134 Reassessment (16.15)
Weekend 8am - midnight (no evening codes!) are H15_.
H151 Minor (22.05)
H152 Comprehensive (54.70)
H153 Multi-system (44.50)
H154 Reassessment (22.05)
Night (midnight - 8am) on any day of the week. H12_.
H121 Minor (25.75)
H122 Comprehensive (63.80)
H123 Multi-system (51.90)
H124 Reassessment (25.75)
There we go, these are the most basic ER billing codes. There will be more postings about other billing codes used in the ER soon!
For more information, the teaching group in London, On. has made a very useful website listing common ER codes:
https://emlondon.ca/clinical/ohip-fee-codes
First let's start with the weekdays
Weekday (8am-5pm)
H101 Minor (14.70)
H102 Comprehensive (36.45)
H103 Multi-system (29.65)
H104 Reassessment (14.70)
For every patient you see, you can use one of these codes. As usual for the ministry there is precious little to guide us what these words really mean. Also peculiar to this system is that there is no "single-system" assessment. So the usual dilemma is when you see a "single-system" disease that is not "minor". So here is my very personal interpretation of these words.
"Minor" assessment applies to very simple service such as refilling a few days worth of anti-hypertensive while the family doctor is away for the weekend. Patient is CTAS 5, there are no acute complaints. Or a patient is referred to ER to insert an IV or a Foley catheter from a family doctor's office. No further assessment is necessary other than your order on the chart. Patient returns to the family doctor's office promptly.
Anything beyond this is "multi-system" more or less. For example, if a person comes in with a cold, you are examining both the lungs and heart. Hopefully you are also checking the head and neck. Maybe an x-ray? Some quick blood work if you are worried about mono? That is multi-system to me.
The next step up is "comprehensive". If you are taking a full history (including family history, social history, systems review) and doing a "full physicial", according to your own definition, then your case is likely comprehensive. An elderly person comes in with pneumonia, has difficulty coping at home, there is some difficult family dynamics, and you are giving fluid and IV antibiotics. This is not a typical "walk-in" type of patient, but rather more of "obs" case as many ERs call them, where you are seeing them over multiple hours to check on the response to the treatment or interpret the on-going diagnostic tests. Personally, I should use this code more often...
"Reassessment" can be used 2 hours after the last assessment. However, you cannot use it if this "reassessment" leads to discharge or a referral. (i.e. a discharge assessment is NOT a "reassessment"!) You can only use 2 "reassessments" per patient per day, and maximum 3 per day between multiple physicians if the patient was already seen by another ER physician. Again, I should use this a bit more often.
Please refer to page A11 in the Schedule of Benefit published by Ontario Ministry of Health for actual wording from the ministry. Yes, it is not clear and yes, it is open to interpretation.
Once you have understood the weekday codes, the rest is easy.
Weekday evenings (5pm - midnight) are coded as H13_.
H131 Minor (16.15)
H132 Comprehensive (40.10)
H133 Multi-system (32.65)
H134 Reassessment (16.15)
Weekend 8am - midnight (no evening codes!) are H15_.
H151 Minor (22.05)
H152 Comprehensive (54.70)
H153 Multi-system (44.50)
H154 Reassessment (22.05)
Night (midnight - 8am) on any day of the week. H12_.
H121 Minor (25.75)
H122 Comprehensive (63.80)
H123 Multi-system (51.90)
H124 Reassessment (25.75)
There we go, these are the most basic ER billing codes. There will be more postings about other billing codes used in the ER soon!
For more information, the teaching group in London, On. has made a very useful website listing common ER codes:
https://emlondon.ca/clinical/ohip-fee-codes
Friday, 14 March 2014
Tale of Suzan Bsat and Mo-Billing
Being a co-founder of a business has challenged me in so many ways, continuously teaching me the ins and outs of how to get a start-up off the ground. Since September 2013, our date of incorporation, I have learned so much.
And while sometimes running a business can consume you, as your focus is always on achieving your next move, you must not forget to celebrate the little milestones along the way.
Carleton shares my story:
http://graduate.carleton.ca/2014/grad-student-suzan-bsat-launches-mo-billing/
http://carleton.ca/engineering-design/2014/suzan-bsat-grad-student-entrepreneur-launches-mo-billing/
And while sometimes running a business can consume you, as your focus is always on achieving your next move, you must not forget to celebrate the little milestones along the way.
Carleton shares my story:
http://graduate.carleton.ca/2014/grad-student-suzan-bsat-launches-mo-billing/
http://carleton.ca/engineering-design/2014/suzan-bsat-grad-student-entrepreneur-launches-mo-billing/
Thursday, 13 March 2014
OHIP billing how-to for Cardiologists
This blog is intended to teach the basics of OHIP billing for cardiologists working in a hospital setting. Generally, as a cardiologist, a patient will be referred to you for a consult. To bill for this first initial consult, you need to determine the following for your initial consult:
Location (where did your initial consult take place?): ER; Ward
Type (the type of consult): General; Comprehensive; Limited; Repeat
Time (time of day you did the consult): Weekday 7:00-17:00; Weekday 7:00-17:00 during Office Hours; Evening Weekday 17:00-24:00; Weekend/Holidays 7:00-24:00; Nights 00:00-7:00
Travel (did you have to travel to go see the patient): Yes; No
Depending on your answers from above we can determine which fee codes to bill to the Ministry of Health for the initial consult. Using your answers follow the breakdown below to find out which codes you need to bill. The first half is for ER visits while the second half covers Ward visits.
If Ward is chosen and…
That covers your fee codes for the initial visit with the patient. Now what happens if you continue to visit the patient daily until they are discharged?
You can use the following fee codes scheme:
Example 1
Note: All this information was obtained from documents made publicly available by the MOHLTC. We are not to be held liable for any occurrences that arise from following our understanding of medical billing.
Location (where did your initial consult take place?): ER; Ward
Type (the type of consult): General; Comprehensive; Limited; Repeat
Time (time of day you did the consult): Weekday 7:00-17:00; Weekday 7:00-17:00 during Office Hours; Evening Weekday 17:00-24:00; Weekend/Holidays 7:00-24:00; Nights 00:00-7:00
Travel (did you have to travel to go see the patient): Yes; No
Depending on your answers from above we can determine which fee codes to bill to the Ministry of Health for the initial consult. Using your answers follow the breakdown below to find out which codes you need to bill. The first half is for ER visits while the second half covers Ward visits.
If ER is chosen as location and…
·Type is:
o
General = A605A
o
Comprehensive= A600A
o
Limited= A675A
o
Repeat= A606A
· Time is:
o if Travel=YES (if you had to travel then no matter the time of day you can bill for your travel and first person seen premiums shown below, known as your special visit premiums)
§ Weekday 7:00-17:00 = K960A, K990A
§ Weekday 7:00-17:00 during Office Hours = K961A,
K992A
§ Evening Weekday 17:00-24:00 = K962A,
K994A
§ Weekend/Holidays 7:00-24:00 = K963A,
K998A
§ Nights
00:00-7:00 = K964A, K996A
o
if Travel=NO (if you did not travel then you can only bill for your first person seen premium shown below; however if you saw the patient during the week from 7:00-17:00 you can't bill for the first person seen premium)
§ Weekday 7:00-17:00: nothing
§ Weekday 7:00-17:00 during Office Hours: K992A
§ Evening Weekday 17:00-24:00: K994A
§ Weekend/Holidays 7:00-24:00: K998A
§ Nights
00:00-7:00: K996A
· If you admitted the patient add: E082A
If Ward is chosen and…
·Type is: (Use these codes, but if both Travel=NO and Time=Weekday 7:00-17:00, use the codes listed after this)
o
General = A605A
o
Comprehensive= A600A
o
Limited= A675A
o
Repeat= A606A
·Type if Travel=NO
and Time=Weekday 7:00-17:00: (Essentially all your codes listed above now start with 'C' instead of 'A')
o
General = C605A
o
Comprehensive= C600A
o
Limited= C675A
o
Repeat= C606A
·Time is:
o
if Travel=YES (if you had to travel then no matter the time of day you can bill for your travel and first person seen premiums shown below, known as your special visit premiums)
§ Weekday 7:00-17:00: C960A, C990A
§ Weekday 7:00-17:00 during Office Hours: C961A,
C992A
§ Evening Weekday 17:00-24:00: C962A, C994A
§ Weekend/Holidays 7:00-24:00: C963A,
C986A
§ Nights
00:00-7:00: C964A, C996A
o
if Travel=NO (if you did not travel then you can only bill for your first person seen premium shown below; however if you saw the patient during the week from 7:00-17:00 you can't bill for the first person seen premium)
§ Weekday 7:00-17:00: nothing
§ Weekday 7:00-17:00 during Office Hours: C992A
§ Evening Weekday 17:00-24:00: C994A
§ Weekend/Holidays 7:00-24:00: C986A
§ Nights
00:00-7:00: C996A
Initial visit: determined using the logic above
Day after
admission: C122A + E083A (The E083A is the premium if you are the most responsible physician for the patient)
Day 2 after
admission: C123A +E083A
From Day
3 after admission to discharge: (Note that you use a different code for these subsequent visits, depending on when you are seeing the patient relative to their admission date. There are restrictions on how many times you can use C607A and C609A).
-
C602A (if 5
weeks from admission) +E083A
-
C607A (if
6-13 weeks from admission) + E083A
-
C609A (if
past 13 weeks from admission) + E083A
Discharge:
C124A + E083A
Our Mo-Billing app actually auto-generates all these codes for you given you provide the admission date, the first day you saw the patient, the last day you saw the patient and whether this was the day of discharge and the location, type, time and travel of the initial consult.To help with the understanding here are 3 examples right from our Mo-Billing app:Example 1
Admission Date: Feb 15 2014
First Seen Date: Feb 15 2014 (Day of initial consult, the first day you saw the patient)
Last Seen Date: Feb 20 2014 (Last date you saw the patient, it is also the discharge date)
Enable autogeneration of codes: activated
Location: ER
Type: General
Time: Weekday 07:00-17:00
Travel:Yes
Feb 15 2014 : A605A (ER and General), K960A, K990A (ER, Weekday 07:00-17:00, Travel=YES), E082A
Feb 16 2014: C122A , E083A (day1 after admission)
Feb 17 2014: C123A, E083A (day2 after admission)
Feb 18 2014: C602A, E083A (I know to use the code for within 5 weeks from admission code since Feb 18 2014 is only 3 days after the date of admission so it falls within this category. If the date was April 5 2014 then I would use the code C607A, E083A since this date falls within 6-13 weeks after the admission date)
Feb 19 2014: C602A, E083A
Feb 20 2014: C124A, E083A (since the last seen date is the same as discharge otherwise I would use C602A again)
Claim Example 2
Admission Date: Feb 15 2014
First Seen Date: April 15 2014 (first day you saw the patient, not the same as admission date)
Last Seen Date: April 20 2014 (last day you saw the patient, not the discharge date)
Enable autogeneration of codes: activated
Location: Ward
Type: Comprehensive
Time: Nights 00:00-07:00
Travel: No
April 15 2014 : A600A (Ward, Comprehensive, Travel=NO), C996A (Ward, Nights 00:00-07:00, Travel=NO)
April 16 2014: C607A , E083A (I know to use the code for within 6-13 weeks from admission since April 16 2014 is 8 weeks and 3 days after the date of admission so it falls within this category. If the date was Sept 5 2014 then I would use the code C609A, E083A since this date falls after 13 weeks from the admission date)
April 17 2014: C607A, E083A
April 18 2014: C607A, E083A
April 19 2014: C607A, E083A
April 20 2014: C607A, E083A (since the last seen date is not the same as discharge)
Claim Example 3
Admission Date: Feb 15 2014
First Seen Date: Feb 15 2014 (first day you saw the patient, the same as admission date)
Last Seen Date: Feb 15 2014 (last day you saw the patient, the same as discharge date)
Enable autogeneration of codes: activated
Location: Ward
Type: Repeat
Time: Weekday 7:00-17:00
Travel: No
Feb 15 2014 : C606A (Ward, Repeat, Travel=NO),
Note: All this information was obtained from documents made publicly available by the MOHLTC. We are not to be held liable for any occurrences that arise from following our understanding of medical billing.
Monday, 10 March 2014
The Art of Creating How-To Videos
Personally, I think that that being the founder of a start-up is one of the most interesting positions you can have. The reason being that you literally get to experience being every department in a company and while it may be a lot of work, you get exposure to so many new experiences.
Yesterday we worked on creating "How-To" videos for Mo-Billing at Ben Hoskyn Studio. Ben is a Ottawa-based cinematographer, director, and producer- and superb person to work with! Our main focus was recording the voice overs for the videos. After spending a couple hours working solely on the voice overs, I came to realize that I underestimated how much thought is needed in producing voice overs. I thought we would do one or two takes, but we did several. We did versions with different tones, word placement and sentence structure. You could spend a whole day trying to find the perfect way to describe something, the right words to use, the right order of the words and sentences. The total product is yet to be completed. Ben will take the many voice over recordings we did, play around with them and overlay them with different parts of the video- quiet an art!
Remember that your video visually explains a lot, so your voice over is intended to be supplemental to your video. In the end you want the voice over to be as succinct and straight forward as possible for your users.
Producing a "How-To" video to simply and quickly explain how to do something can be challenging but spending a couple hours finding the right words to use and the order to place them are the starting steps.
I've added some pictures of us hard at work!
Yesterday we worked on creating "How-To" videos for Mo-Billing at Ben Hoskyn Studio. Ben is a Ottawa-based cinematographer, director, and producer- and superb person to work with! Our main focus was recording the voice overs for the videos. After spending a couple hours working solely on the voice overs, I came to realize that I underestimated how much thought is needed in producing voice overs. I thought we would do one or two takes, but we did several. We did versions with different tones, word placement and sentence structure. You could spend a whole day trying to find the perfect way to describe something, the right words to use, the right order of the words and sentences. The total product is yet to be completed. Ben will take the many voice over recordings we did, play around with them and overlay them with different parts of the video- quiet an art!
Remember that your video visually explains a lot, so your voice over is intended to be supplemental to your video. In the end you want the voice over to be as succinct and straight forward as possible for your users.
Producing a "How-To" video to simply and quickly explain how to do something can be challenging but spending a couple hours finding the right words to use and the order to place them are the starting steps.
I've added some pictures of us hard at work!
Friday, 7 March 2014
Mo-Billing Featured by Invest Ottawa
When I started the GrindSpaceXL program at Invest Ottawa one of the first things we were told is: "What you get out of the program depends on what you put into the program". Makes sense.
Simply being a part of the GrindSpaceXL program teaches you how to take a start-up from an idea to product to sales, and everything in between- information that is essential to someone without a business background (such as myself). However, to truly get the most out of the program you need to put what you learn in the classroom to practice. I think of GrindSpaceXL as one of the many university classes I have taken in the past. You sit through class, learn a lot of information, then to make that information stick, you have to do your homework. In our case, our homework is taking the concepts we learn in class and figuring out a way to implement those concepts within our business.
Read about how doing things this way has really paid off for us in the article written by Invest Ottawa:
http://investottawa.ca/insiders-view-grindspacexl-driving-sales-mo-billing/
Simply being a part of the GrindSpaceXL program teaches you how to take a start-up from an idea to product to sales, and everything in between- information that is essential to someone without a business background (such as myself). However, to truly get the most out of the program you need to put what you learn in the classroom to practice. I think of GrindSpaceXL as one of the many university classes I have taken in the past. You sit through class, learn a lot of information, then to make that information stick, you have to do your homework. In our case, our homework is taking the concepts we learn in class and figuring out a way to implement those concepts within our business.
Read about how doing things this way has really paid off for us in the article written by Invest Ottawa:
http://investottawa.ca/insiders-view-grindspacexl-driving-sales-mo-billing/
Tuesday, 4 March 2014
Mo-Billing For Billing Agents
Most of the time when we blog about Mo-Billing, it is aimed primarily at physicians, so I thought I should write about how the technology could change the billing agent workflow.
While Mo-Billing is aimed at eliminating the use of paper on the front-end for physicians by providing them with a platform to collect, store, deliver and retrieve their billing information we must not underestimate its advantages in the back-end.
For billing agents, they too, are able to eliminate the use of paper and computer ink. Rather than receiving their clients claims by fax or by email, which they must print, they are able to log on to our server and access their clients claims electronically. They are able to organize their clients claims through our electronic system, eliminating the need to physically file physician claims. This could save some serious space, as we have found billing agents can store old claims anywhere from 1-3 years after they have been submitted to the Ministry of Health. Also, we have found that eliminating paper and ink can save a significant amount for a medium-sized billing agency.
Another advantage for the billing agent, is they are able to receive claims on a continuous basis. As soon as the physician finishes the claim and clicks 'submit' the billing agent immediately has access to it. This helps them avoid cramming close to the end of the billing cycle.
Billing agents are valuable to physicians as they have expertise in billing, sometimes getting more money for physicians than they would know to claim on their own. Also, billing agents are great at dealing with claim errors and rejections- often a time-consuming task for physicians.
Hopefully Mo-Billing will provide billing agents with a tool they can use with their clients, which will allow them to stay at pace with our societies technological advancements.
While Mo-Billing is aimed at eliminating the use of paper on the front-end for physicians by providing them with a platform to collect, store, deliver and retrieve their billing information we must not underestimate its advantages in the back-end.
For billing agents, they too, are able to eliminate the use of paper and computer ink. Rather than receiving their clients claims by fax or by email, which they must print, they are able to log on to our server and access their clients claims electronically. They are able to organize their clients claims through our electronic system, eliminating the need to physically file physician claims. This could save some serious space, as we have found billing agents can store old claims anywhere from 1-3 years after they have been submitted to the Ministry of Health. Also, we have found that eliminating paper and ink can save a significant amount for a medium-sized billing agency.
Another advantage for the billing agent, is they are able to receive claims on a continuous basis. As soon as the physician finishes the claim and clicks 'submit' the billing agent immediately has access to it. This helps them avoid cramming close to the end of the billing cycle.
Billing agents are valuable to physicians as they have expertise in billing, sometimes getting more money for physicians than they would know to claim on their own. Also, billing agents are great at dealing with claim errors and rejections- often a time-consuming task for physicians.
Hopefully Mo-Billing will provide billing agents with a tool they can use with their clients, which will allow them to stay at pace with our societies technological advancements.
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