7 ‘Medical Billing’ Best Practice Tips & Go to Resources
Whether you’re a new grad, unsure exactly how medical billing in Canada works, or you’ve just changed provinces and are feeling a bit overwhelmed with the different claim policies, medical billing can sometimes be a daunting task. It’s hard to keep track of fee codes, rules and diagnoses.
Even for experienced doctors, it’s been known to cause its fair share of headaches. In saying that, it is an important part of your career, as not only does it determine how much you’ll be paid, it’s also used to collect data and keep a record of all the services you’ve provided.
Therefore, to help with the frustrating realities of billing, we’ve put together a list of 7 medical billing best practices and some go to resources. By implementing each tip you’ll be more organized, find the answers you’re looking for faster, and reduce the amount of stress associated with billing.
7 ‘Medical Billing’ Best Practice Tips & Go to Resources:
1. Bookmark these Fee Code Databases
A major setback when submitting claims is when you’re not sure what fee code goes with what procedure. No matter what province you’re working in, fee codes are outlined in the provincial schedule of benefits, (which is a long PDF of confusing descriptions and multiple specialities).
A better way to find the fee code you’re looking for, along with its rules, is to search our online databases. You can search by code, specialty or keyword:
2. Create a Billing Cheat Sheet
Once you know which codes are available within your specialty, create your own cheat sheet so you can reference it quickly.
Make sure to add premiums, restrictions, etc. We suggest setting something up like this:
|Fee Code:||Description:||Premiums/Modifiers||$ Amount|
|A263A||general assessment paed||E078A (Chronic Disease Premium)||$77.70|
Knowing what’s available to bill will make it easier to bill properly the first time. For instance, Dr. Melissa Gansner, a psychiatrist in British Columbia, told us that it helps her to have a visual reminder of indirect billing codes at her workplace (for phone calls, meetings, emails, forms etc.). That way, she actually remembers to use them.
Premiums act like a bonus on top of regular fee codes and are great incentives if you’re working under specific specialties or sub-specialties. You can also use premiums for working over-time, on weekends, holidays, etc.
Alberta Medical Billing Premiums
Billing guides are not only a great to see exactly what’s available within your specialty, but also a great way to learn what the rules are and how to use them.
While there aren’t billing guides for every specialty (yet), here’s some current guides that are available:
3. Bill Daily
You want to make sure you’re getting paid properly for the work that you do, which starts with remembering what you’ve done.
Make sure you get into the habit of billing daily so that your patients are still fresh on your mind. If you’re billing on your phone, try to incorporate billing into patient care. For example, after you see a patient, pull out your phone and bill for it right away so that nothing gets piled up.
Try using the Label Snap feature to quickly snap a photo of each patient label.
If you can’t bill right away, take a label snap as soon as you have your patient’s information so it’s saved for later. Then, try booking an extra empty slot every one or two hours to catch up.
In general, if you’re looking to increase productivity, you should get into the habit of finishing tasks the first time you see them, whether that’s signing off on a result or sending a lawyer's request for processing. This is critical, otherwise things will start piling up quickly.
4. Understand Cut-Off Dates
Depending on where you’re working, each province has its own cut-off date, which means you need to submit claims before that date if you want to get paid in time.
For an easy reminder bookmark or download your province’s shareable calendar here:
All medical billing claims must be submitted within a certain time frame, otherwise they won’t be eligible to be paid (just another reason why you should get into the habit of billing daily)!
If you are submitting past claims, make sure you follow your province’s deadlines:
All claims need to be submitted within 90 days of the original date of service. Claims that are submitted beyond this deadline will be refused with a BV explanatory code from MSP. While you can attempt to recover these over-age claims MSP requires a valid reason for the delay.
All claims need to be submitted within 180 days (6 months) of the original date of service. However, OHIP only accepts RAI’s (Remittance Advice Inquiry) within 3 months. This means if you submit an over-age claim that’s more than 3 months old, you won’t be able to modify it if there’s a problem.
All claims need to be submitted within 180 days (6 months) of the original date of service. Alberta has a very strict policy and over-age claims are only accepted under extenuating circumstances (such as flood, fire, fraud, etc.), otherwise they will just go unpaid.
5. How to handle Error Codes and Rejections
Shortly after the cut-off date, the ministry of health releases Remittance Advice (RA) reports and Error code reports. These reports outline which claims have been paid, paid with adjustment, or rejected.
You should be able to access your reports through the billing service you’re using, as generally they’re integrated with your province’s web service. For example, here’s an active claims status report on Dr. Bill for Alberta:
BC and Ontario display the same details. Keep in mind though, that these reports are live so numbers will always change depending on whether claims are being resubmitted or released.
If a claim does have an error, it will be outlined on the error code report accompanied with a code. The code will explain what’s wrong with the claim.
You can find out what the code means, and how to fix it, through these searchable databases:
The most common medical billing error codes are usually due to:
No Referring Physician
The Patient doesn’t have insurance
Invalid use of Premiums
There’s a fee code conflict - so assessment is required
Location of fee code doesn't match. Ie, radiologic fee code performed in ER
Reminder: In BC and Ontario to change an error code you just resubmit the claim with the necessary changes. However, in Alberta, you need to submit a new claim using action code A.
Sometimes, your claims might be rejected or paid at a reduced amount. When a claim does get rejected, or is reduced, you can resubmit the claim or inquire to appeal the decision. Re-submitting rejections varies depending on the province.
To fix a rejected claim in BC just make the necessary changes and resubmit the claim. In BC, rejections and error codes are all found on the searchable database as mentioned above.
To inquire or fix a rejected claim in Ontario you need to fill out the Remittance Advice Inquiry form. This needs to be done within four months from the issue date of the RA report (that detailed the claim in question).
If you need to correct and resubmit a rejected claim in Alberta, or if you disagree with the reason why the claim was rejected, you must resubmit the claim with action code C (change) or R (reassess). In Alberta, rejections are called ‘paid at zero.’
Billing Tip: Rejections are confusing and time consuming. Make sure your billing service provides some sort of rejection management. This will help save you a lot of time (and money too)!
At Dr. Bill, if you are on our Full-Serve or Premium plans, we will automatically correct and resubmit any rejected billings or error codes (sounds nice right)?! This has led us to recovering 86% - 96% of rejections that might have otherwise gone unnoticed or sat as refused.
6. The Better Billing Newsletter
The Better Billing newsletter is a bi-monthly newsletter that we send out to Dr. Bill users. Each issue offers billing tips, new feature tutorials, podcast picks and continuing education suggestions.
Even if you aren’t a Dr. Bill user, we post each issue on our blog so everyone can stay up-to date and bill better. Here’s our most recent newsletters:
BC: Tips to avoid rejections for Consults/Visits, Conference calls, Rural Locations
Ontario: Avoid Rejections on Counselling Codes, Related codes, Shared Claim’s tutorial
Alberta: the CMGP modifier, Shared Claims & Conference calls
7. Extra Resources
Having a good understanding of billing and being able to easily navigate fee code changes is a great way to reduce the risk of being audited, while still making sure you’re being paid properly.
Here’s some extra resources you might find useful (don’t forget to bookmark them for easy searching):
With mobile billing and automated services, billing is finally getting easier. If you’re really looking to maximize your medical billing potential and reduce the amount of time you spend on it, make sure you understand the fundamentals of billing:
Know the billing cycle
Know what fee codes are available within your specialty
Understand claim errors and how to fix them
Understand rejections and how to fix them
Feeling overwhelmed? If you have any questions about rejections, fee codes or getting started in billing, reach out to our team and leave us a detailed message - we’ll get back to you asap.
Working in Ontario?
Check out the Ultimate OHIP Guide to Billing that outlines every aspect of Ontario Billing, from registration and how to get started, to maximizing your earnings!