Am I Underbilling? Billing Optimization for the Underpaid & Overworked Family Doctor

Welcome & Acknowledgements

Paul Roscoe (OntarioMD) 

My name is Paul Roscoe and I'm the Director of Business Development at OntarioMD. It's my pleasure to welcome you to our new series OMD Vendor Spotlights, a collaborative series that highlights companies driving transformative change in healthcare through cutting edge digital tools and technologies. 

As a visitor on this land, I would like to begin this afternoon by acknowledging that I am joining from the Greater Toronto Area covered by the Toronto Purchase and Treaty 13 of 1805.

This land is the traditional territory of many nations, including the Mississaugas of the Credit, the Anishnabeg, the Chippewa, the Haudenosaunee, and the Wendat peoples, and is now home to many diverse First Nations, Inuit, and Métis peoples.

We thank all generations of people who have taken care of this land and recognize and deeply appreciate their historic connection to this place.

Before I introduce our hosts, a few housekeeping notes. Please note these sessions are sponsored. Sponsored webinars are not affiliated with, endorsed by, or funded by OntarioMD, OMD Educates, the Ontario Medical Association or any of their affiliates. This session is being recorded and will be available on the OntarioMD website next week. 

Please post any questions you have in the chat throughout the presentation. And finally, if you're having any technical issues, please monitor the chat where we'll be posting troubleshooting links. And now I'd like to welcome our sponsor, Dr.Bill.

Chris Handscomb (Dr.Bill)

Thanks very much Paul. Very excited to be here today representing Dr.Bill. And we're also joined by a very special guest whom I'll introduce shortly. 

For those of you who are not familiar with Dr.Bill, we are a medical billing platform and our mission is to streamline the medical billing process and help physicians get paid giving time back to what matters most, patient care. Dr.Bill was founded in 2014 in Vancouver, and since inception has continued to grow, now servicing physicians across Ontario, British Columbia and Alberta.

In 2022, Dr.Bill acquired MDBilling.ca to further strengthen and expand the OHIP service offering, effectively bringing Dr.Bill to a total of 25 years’ experience in medical billing. Today, Dr.Bill services over 10,000 physicians, 125 group practices, and is the largest standalone medical billing provider in Ontario servicing one in five Ontario physicians. 

As of 2024, Dr.Bill has processed 5 billion dollars in gross billings for Canadian physicians. My name is Chris Hanscomb. I'm a Senior Medical Billing Consultant here at Dr.Bill. While at Dr.Bill, I've worked directly with hundreds of physicians, hospitals, and clinics across Canada to help drive efficiency in medical billing. I've spent about 15 years working in Canadian finance and technology and with Dr.Bill, I really focus on the intersection between financial services and technology, specifically to Canadian healthcare. We're seeing more and more physicians, whether it be within clinics, hospitals, or health networks, explore the benefits and efficiency derived from having a more unified approach to medical billing. This is really where I spend the majority of my time - working with these individuals and groups to help understand options to optimize medical billing. 

Now, joining me today is our guest speaker and presenter, Dr. Stephanie Zhou. Dr. Steph, thank you so much for joining us today.

Dr. Steph practices addictions medicine at Sunnybrook Hospital Family Medicine at Don Mills family health team and is an assistant professor for the financial literacy curriculum at the University of Toronto Faculty of Medicine. She also serves on the board of directors for Toronto Public Health. 

Along with her medical practice, Dr. Steph is passionate about all things finance. She began by giving affording medical school webinars to the community of support students and has developed the family medicine billing lectures currently used at the UofT Family Medicine Residency Program. You can find her content on personal finance, billing and practice management through her social channels on Instagram and YouTube titled @breakingbaddebt. 

And I actually refer Dr. Steph a lot of your contact to many of the physicians I speak with, and I know they get a lot of value from your channel. I don't imagine there's a whole lot of spare time in your calendar. So again, we thank you for being here today. The title of today's webinar is “Am I Under Billing? Billing Optimization for the Underpaid and Overworked Family Doctor”. Now we've had over 950 individuals register for this webinar, so it's clear this topic is top of mind for a lot of physicians. So without further ado, Dr. Steph, I'm going to pass it over to you.

Introduction & Billing Resources

Dr. Stephanie Zhou

Great, thank you for the introduction, Chris. And so let's begin since we only have an hour today. Okay, so I'm going to skip the intro because you've already given a very detailed intro, but basically just want to talk a bit about my practice first. So I currently am the FHO lead and I work two full days of family medicine managing a roster of anywhere between 750 to 850 patients. And the other days I do addiction medicine, inpatient and outpatient clinic. Those are three days a week and somewhere fit all through in there, I also give lectures, I do research and a bunch of academic stuff. I also record my lectures and put them on YouTube so that way if you didn't get billing lectures in residency, you can watch them on YouTube as well. Plus I have a newborn, so that's been very busy and fortunately she's now fallen asleep right at the start of this seminar.

So we're going to do several billing cases and the billing cases, you'll have a poll pop up on your screen so you can submit what you think is the answer and you'll see what your other colleagues submit as well, because the best way about learning, billing and how to determine if you're overbilling or more likely under billing is by seeing what your colleagues are billing as well. So this is the high yield portion. So the target audience for today's talk are family doctors who've been in practice for a few years. You've already known the basic codes, just want to optimize your income. The previous talk I gave back in January that was more geared towards a beginner level, but if there are certain questions, maybe you are new in practice and you're not as familiar with some of the billing codes, feel free to post them in the chat, and Veronica, who's from Dr.Bill will try to answer them during the talk.

I'm going to briefly go through this because for people who have attended my first talk, you might have already seen these slides, but I want you to know this information so that way you'll have all of these resources in the back of your pocket. So of course it's hard to know everything in family medicine, so it's more important to know where to look to find the answers. So the first resource that you should have, and I think Chris will post it in the chat, is the SGFP billing guide. Usually in my clinic I will have this guide on one tab and then my EMR on the other tab. And then after I see a patient, I type my note, I bill immediately while the billing is still in my head, all the information is fresh in my head, and so I'll control-find on this.

And when we're working through the billing cases, it might be helpful to have this in the background to help you answer the question. The second resource is the schedule of benefits, which I've also have provided a link as well. And a schedule of benefits provides additional information. So if the first SGFP document is not that clear to you and you just want more context about the billing, this is where you can go to get it. The third resource are these billing lectures. So let's say if you missed the first billing lecture, you can always watch a recap of it on YouTube. Those are just recordings I've done for like McMaster, UofT and so on. And if you're specifically a FHO doctor because FHO billing, we'll touch a bit about FHO billing in the practice cases. But if you're a FHO doctor, the billing can be quite different when it comes to optimizing it.

So there is FHO-specific lecture that I developed, actually two parts specific lecture. It's just so much more complex. So that was the basic billing lecture that we won't go through today. And then finally, if you want some of my templates and resources in the description of the first lecture, you'll find a Google Drive and it has a lot my family medicine templates on there. The fourth resource I want you to know about is the OMA billing guide. There's no link. You have to log into your OMA account and you'll see these modules on there as well. Final resource is the first five years in family practice Facebook group. It doesn't matter if your first five years or 10 years and so on, you're still allowed to join. And I find it's really helpful because when I joined in my first five years, I asked a lot of questions about where do I refer someone for this or what do I bill for these? And oh, if someone has an ethical situation that they're not sure about, should you contact CMPA? What would you do in this context? You'll get a lot of resources from your supporting physicians. Finally, in terms of disclaimer, these slides are for education purposes only. I am paid a team stipend for delivering this lecture. So Brooke is going to put up a poll first just so that we can see where people are coming from. Are you coming from a focus practice? Are you coming from a fee for service model? Where are folks in their practice? Because depending on your type of practice, it can affect how you bill. So someone who bills strictly fee for service in a walk-in setting may bill very differently than someone who is in a FHO practice setting. So once you'll see that poll pop up on your screen, and it looks like, I'm not sure if other people can see all the responses, but it looks like the majority of people are coming from general family practice, so FHO/FHG models. And the second most common one is telemedicine or walk-in fee for service. So we'll try to cover a little bit about FHO billing, a little bit about fee for service billing in today's talk as well. And then there's a smattering of emergency room focus practice and so on.

And this is what I usually get from new grads or all about to graduate. A lot of them are also just like yourselves hoping to enter FHO and FHG models. And actually quite a lot of people are interested in focus practice more than the group that we have here today. 

Billing Case #1: EH2 Rejection

So let's begin the practice cases. So the first case is about rejected billing. So Brooke will post that on the screen and you can vote for what you think is the right answer. So I'll read it out loud as the poll is being put up. So a patient comes into the walk-in clinic, so that's a fee for service model for cough, and your billings get rejected due to an EH2 error. So that's defined as OHIP version code is expired. What is your best option? So would you a), write off the billing, it was only 37 bucks. b), call the patient to ask them to come back with an updated health card. c), send the patient an invoice for $37.95 and ask the patient to renew their health card, then refund them when the billing gets approved or d) call the health number release service. So I just wanted to check that the poll is showing up here.

Brooke Baker (OntarioMD) 

Dr. Steph, we're just having a bit of an issue with the polling. If you could just have everyone comment in the chat. 

Dr. Stephanie Zhou

In the chat, right? Okay, no problem. Let me take a look at the chat and see what people are writing. It looks like most people are submitting either B or D, right? B or D is what I see more often. I actually can't see how many people, but it looks like B or D. Okay, so what is the answer? So B could be right, but I put D and then C can also be right as well. So you'll see there's many different right options, but which one is the more correct answer? Why do I put C and D? So B, remember this is a walk-in setting. So you call the patient, the patient might not come back, they're just there for a one time thing, right?

So you tell them, oh, come back with an updated health card. A lot of them, especially if they are very transient patients, they won't come back with an updated health card. And how do you get paid? Some people I see in the answer will say, send the patient an invoice. That's totally okay as well. But again, when you're sending patients invoices, sometimes they don't pay the invoice. And when you tell the patient to renew their health card, they are very busy people. They might not have the time to go and line up at ServiceOntario to renew their health card or they don't want to do it online. So that's why I put D call the health number release service. So how do you sign up for the health number release service? Before I get to that, I just wanted to post this resource, which tells you what is all of the error codes.

Oh yeah, sometimes you mean never. That's true. 

So how do you sign up for the health number release service? First of all, it is a little bit confusing in the beginning, but later on you'll start getting the hang of it and you can even delegate this to your secretary, to your office manager to do as well. So first of all, you have to email 24x7@ontario.ca to get a eight or nine digit pin. Once you get that pin, that's what you need in order to call the health number release service. So sometimes someone said newborns, right? The newborns don't have the health version code necessarily. They might just have a health number. Sometimes people who are more in the older age, geriatrics, they're bedbound or they're home bound, they don't go out to renew their health card. So then how do you get paid?

Once you have their name, you have the health card number, maybe not the version code. Once you have the rejection code, which is EH2, you can call this number, provide them with your pin as well as some of this information in order to get their version code as well. And sometimes people you get their billings rejected because they don't have an OHIP number. They might be not from Ontario, so you can still bill OHIP to a reciprocal provincial payment program. So you just need that patient's health card number, whether it's from BC or Alberta for example. The only difference is Quebec. Quebec, it doesn't necessarily work that way. So in that case, you can bill a patient directly and then the patient goes and submits the claim to get reimbursed, or you can send an invoice to their provincial health system, but that takes longer as well.

So like I said, similar service. If they have expired out of province healthcare number that, not that I know of if their actual number is expired, but usually the version code tends to be expired 

in Ontario, and that's the service you can use as well. 

Billing Case 2: House Call & Travel Premium

Okay, so second situation, I'll see if the poll can be put up. I just wasn't sure if it's working now you cancel your clinic that day to do a house call. Oh, good poll is working. So that should appear on your screen to do a house call for an elderly patient with severe arthritis and dementia.

So click the answer you think is right on your screen. So I'll give people a few moments just to vote and let's see what people are voting for. So I see most people have submitted their answer, so you don't have to post it in the chat. Now the poll is working,

So it looks like most people selected C. And you're right, the answer is C. So one of the ways that people often lose out on income, oh, someone said they can't see the poll, it should technically pull up on the screen. I can see people are selecting answer here, but let's talk about why it is C. So sometimes people lose out on billings because they use the SGFP billing guide, but there are certain codes on there that are actually obsolete or expired, and so they might bill it and then they get rejected and they don't know why they got rejected. So this is just a heads up that A901 is now obsolete. The other codes on here are if you're doing a house call, there's home visit premiums, and this is an area where you can also optimize your billing as well, because I have a colleague who's 60 years old and he's been doing hospital visits if they're on call and sometimes home visits.

But he says, oh, sometimes I go into hospital, I get called and the patient doesn't want to see me, so I wasted gas going there. But there actually is a billing code, a travel premium specifically that can help you cover a bit of the cost of traveling to this. So the reason why it's B992 is because you sacrificed office hours, you canceled your clinic that day, and you also get to bill a corresponding travel premium. So this travel premium, you only bill once when you go to the patient's house, you can't really necessarily bill it if you are coming back from the patient's house to your own house. So that's just how that travel premium works. Okay? Okay. 

Billing Case 3: Combination Codes

So combination codes, I'll let Brooke pull that poll up onto the screen. This can often be an area where people miss out on billings when they don't know how to combine certain codes as well. So I'll give folks a bit of time to submit their vote. So that should pop up on your screen there.

Chris Handscomb (Dr.Bill)

Just as a reminder for everyone, there's a few people who mentioned they couldn't see the poll. It does appear in the chat window, that you hopefully can answer on there.

Dr. Stephanie Zhou

Yeah, and someone just asked, I see a question pop up, someone just asked, is it okay if the whole day is canceled or you canceled half the day? Yeah. So if you were normally going to have a clinic or some office hours that day and then you decided not to because you want to do a home visit, that still counts as well. So I'll let people submit their answer.

I'm just going to see what people are voting for. Okay, let's see. The most common people voted for is A, and then someone puts the second most common that people voted for is C. Let's see what the answer is. So I put the answer as C. So diabetes codes are often some of the most confusing for people. So this is where a lot of people might get a rejection because it is common that you might see someone with diabetes and maybe they smoke as well, but in this kind of particular case, when you bill K030 and E079, you can't actually combine those together. And a lot of people don't realize this. So E079, this is from the schedule of benefits. It's only eligible for payment if in conjunction with the below codes. And you'll see here K030 is not listed down below. So yes, you can combine E079 with A007. That's a possibility as well, depending on your payment model.

So if you're fee for service, maybe you might want to do this, but if you're in a FHO or any sort of capitation FHO or patient enrollment model or PEM; C might be the better answer. Why is that? Because K030, if you bill at least three of them, it unlocks a bonus code, which is the Q040, which we will touch on in a later case as well. There isn't exactly a max of K030s. You can bill technically you can do as many diabetes visits as you want, but generally speaking, we generally it's every three months is when we generally bill a K030.

To my knowledge, from what I've seen with my patients, I haven't actually billed a maximum. Yeah, exactly. I haven't necessarily reached a maximum for K030 oh, someone's saying K030 a maximum a four per year. Yeah, exactly. So if you're noticing that the max is four per year, then that would be the maximum For myself, I've never had to bill more than four times generally how I schedule my K030. So I usually schedule a diabetes visit with patients every three months. So let's talk about another type of combination code. So someone asks, so in the end the answer is C or D, not just C. Not everyone is in a FHO, exactly. So if you're in a FHO and it unlocks the Q040 codes, then C might be better. But if you're in a patient, not in a patient enrollment model, sometimes A007 plus E079 could be a possibility as well. But in the end of the day you just have to see which one pays higher amounts for you. Okay, so I'll let Brooke pull up the next poll, another combination code question.

Billing Case 4: Combination Code House Call

Okay, so you canceled clinic to respond to an urgent house call between three to 4:00 PM on a Wednesday and the patient has palliative breast cancer. What would you bill here? So what you'll start noticing with these questions is sometimes there can be multiple right answers. Just like with the previous question, there could be multiple right answers. That's why I say it can be difficult because a FHO might bill one way, a fee for service might bill the other way. This is I've developed these cases so that it can kind of stimulate these discussions. So let's just see what people are voting for in this case, let me just see what people are submitting is their answer. So it looks like the vast majority of people voted for A, okay, and then the second voted for B. So B could also be correct as well. But in A, it's because in a K023, this is a palliative breast cancer case, right?

So yes, even though you did a house call, just like in that first question, the earlier question we did, if there is an alternative billing code that's just as legitimate, why not just bill the alternative billing code that pays more? So this does pay more than the A900, which was in the previous question. And then you have your corresponding B998, which right here, palliative care patient all other times and see this one pays more than the sacrifice office hour, right? So it's 82.5 and it has a travel premium with that as well. So that's why I put A as the answer for this case. So often physicians might lose out on income because they might bill a certain code, there's an alternative that might be higher. So you always want to look at, in this particular case, could there be a higher billing code as well?

And someone did mention in the chat, potential advantage of A900 is if you're a practice patient enrollment model PEM and closer to reaching the annual bonus of 1224 et cetera visits. Exactly. And so that's where sometimes FHO, FHG and fee for service billings can vary as well. So you'll have to kind of see if you're close to reaching that annual bonus, et cetera. And someone asked, can you bill B992 and B998? You can't bill those two together, the B998 and the 992 together. Usually you build a 998 or one of these ones the home visit ones with a travel premium. So personally, I've never billed two B codes that are home visit premiums together. Okay, let's pull up the next poll on the screen. 

Billing Case 5: Physical + FIT test

So you do a complete physical for a 50-year-old where you counsel him on his cholesterol and you provide him with a FIT test. So this poll should appear on your screen

And what would you bill? So again, this is another one of those examples

Where there could be multiple right answers and this is where you can learn from your colleagues. And see, what would your colleagues bill? So let's

Just see what people voted for. So I see here, yeah, so some people

Are writing A, some people are writing B, some people say K013 is almost as 20 minutes fee for service K131. What pays more than someone said auto pay K033. But some notice FHO billing is in basket. Exactly. So you can see there's such a huge range of what people are writing, right? Someone also wrote A003 plus Q150, which is not actually in the answer choices, but could be a potential as well. So you can see there's so much variation on billing. So for this particular case I put B as the answer, but like I said, although it's the answer on this case, it could be other alternatives as well. But let's talk a little bit about what this particular case is getting at. So earlier I mentioned that sometimes there could be different billing codes that you can use all for one case.

And so in this particular case, why did I put K013? So yes, even though at the face of it you're doing a physical with the patient, a physical exam is K131, it pays about 50 or so, but during the physical, you're also spending time talking to the patient about their cholesterol. And let's say you counseled them for a good 20 minutes. If you did do that, then that unlocks the K013 code because you counseled them as well. So that's why although A and B could potentially be correct, that is why B was selected in this case. And I haven't had rejections with K013 plus Q150. Personally I haven't had any of that rejections, so that's why I have built this combination as well. But in terms of these, there could be a possible, someone in the chat also said, what about an A003, a general assessment?

Now this depends. Yeah, so several people are asking why not A003 plus Q150, so A003, it tends to be more so where you have a specific certain issue. So for example, in this case he's talking about his cholesterol and you do a full physical, I guess you technically could, but it depends on your diagnostic code that you use. That's the main thing. So if you're diagnostic code is 917, which is the diagnostic code for annual physicals, then you wouldn't be able to bill the A003. But if he specifically has a medical issue that kind of requires a full workup. So let's say if it is the cholesterol and he's saying, I also have chest pain doc, let's talk about my diet and whatever. Then in that case, or yes, if the diagnosis is hypercholesterolemia, someone said and you use that diagnostic code, then that could potentially unlock the A003 plus Q150 as well. As you can see here, there could be multiple billing options and exactly as long as you do full exam not including genitals. Exactly. So that's where we're going to get at with this particular question. 

Billing Case 6: Physical + Chest Pain

So scenario six, and I'll let Brooke pull up the poll here. A 64-year-old patient presents with an annual physical where you also address this chest pain. What do you bill and what diagnostic code do you use?

Exactly. So someone in the chat, I see they mentioned if you're having to choose between the K131 and the K013, if you try to bill K131 and the K013 together, you might face a rejection or the one that pays less tends to be the one that gets paid out instead. So that's where it also involves a little bit of time management as well, right? Someone has says K013 for FHO if the majority of visits best reflects counseling. And that's a good point too because if you're in a FHO the K013, if you've billed three of them after that, it unlocks K033, which is out of basket code as well. So let's see what people voted for in this case, just give people a few minutes to select their answer and I realized the answers may not be in order, but so it looks like most people selected C as their answer, and this is kind of where I was getting at. So the previous question led to this question where some people had posted in the chat the A003. So yes, even though technically you could bill a annual physical, a K131 annual physical, what is an alternative building code you could consider for this particular case? Because often in an annual physical you don't necessarily only do a physical, sometimes there is a particular issue the patient wants to address as well. And so if it's an issue that really warrants a full systems examination, then you might want to bill the higher billing code for that as well. And so when you look on the schedule of benefits, a periodic health visit, what is the definition of a K131?

This is a general visit where the patient reveals no apparent acute physical or mental illness. And so this is kind of what they define. It kind of looks like it's defined as for someone who's pretty healthy and just doing a general exam, not necessarily because there is a specific issue like chest pain that they are bringing up. So that's why I wanted to point this out to you because sometimes I find a lot of doctors under bill their annual physical by building the code that's annual physical because it's pretty obvious it says physical, but often patients will bring up other stuff during annual physicals that might warrant a different code as well.

Okay? So it looks like most people got the right answer for that. Alright, so let's pull up the next scenario. 

Billing Case 7: Physical + Pap + Dizziness

Scenario seven. This is a case where a patient comes in for an annual physical, but you also do a Pap test and you also assess them for dizziness. What would you build? Would you build a K131, just annual physical code plus G365 + E430? Would you build an A003 we discussed in the previous case plus G365, would you bill A003 plus E430 or would you bill a K132 and so on? So let's see what people are voting for and sometimes it's

Hard for me to see the questions because the chat moves so fast. So I'll give

Veronica some time to answer some of the questions, but let's just see what people clicked for this.

Okay, so let's see what most people are voting for here. So it looks like

Most people clicked B - A003. So what is the answer in this case? The answer in this particular case I put down is A. So why is it a right? This is where it gets a bit confusing. So A is the annual physical plus your Pap smear codes, but why is it not the A003 in this case? This is where it gets confusing. An A003 actually does not include the Pap smear, the Pap smear code, right? The G365. So it's very unusual. This is like why is it like this? But this is just how the billing system is, right? So that's why I'm pointing out to you some of the nuances in the billing system and A003, it's expected to include all of the G365 and so on. Whoops. So when you kind of add up all of the billing, right?

The $50 plus $12 plus $11.95 A ends up the total sum of the billing ends up being more than C, which is the other alternative. If you clicked B, the G365 would not be involved, it would not be allowed as part of that billing combination. So this is where it can get a bit confusing as well. So that's why I wanted to use this case to point that out to you. I personally don't necessarily know why. So if someone said A003 can include tray fees, so total is higher than K131 plus Pap tray. Yeah, so you'll have to see I think with the new K131 it might actually be higher $12 plus $11.95, whereas on the SGFP document it hasn't been updated. So the G365, I think on there it might be like $5 something maybe less, but with these two plus this, I think A might end up being higher. Then C. C would've been the other alternative. So the A003 plus the tray fee. 

Billing Case 8: FHG Walk In

Okay, so the next scenario, this is kind of for people working in a FHG model and this is where you'll see there's a little bit of a difference between.

FHG and FHO model. So let's see what people are voting for.

So someone had said I'm in a FHG when I build A003, G365 E430 has never been rejected. You might want to double check, maybe it hasn't, but for some cases it has. And then someone says technically can't do G365 with an A003. And that's kind of what I've noticed as well. So that can for myself when I build A003 plus G365, sometimes it can get rejected as well. Okay, let me just see what people are voting for in this case. So you're working in a FHG model and you do Sunday walk-in clinic, what would you vote for?

So it looks like most people are selecting B as the answer and either A or B are fine, but I agree I would personally choose B a little bit more than A. And why is that? So when you go on your SGFP documents, you'll see this Q012, it's like a after hours bonus code and so it applies to only these codes down below. It can apply to A007, it could also apply to A888, but why A888? It's because A888, it is not relevant to FHG models, but it's good practice for your FHO colleagues, right? Because when you bill A888 it is out of basket as you can see by the N and the O. That's a visual signal that it's out of basket so you don't negate your colleagues in the foe. So either those two, they pay the same, you're absolutely right. So that's why both of them are right, but if you want to be a good colleague to your FHO doctors, that B might be a better option then A. Okay. Alright, so I'll let Brooke pull up the next scenario. 

Billing Case 9: Rostering from Health Care Connect

Scenario nine, you are rostering a new patient from healthcare connect with a complex medical history.

What would you bill? So I'll let her pull up the poll and we'll

See what people vote for. First, people who are starting their own practice, sometimes you might get patients from Healthcare Connect and for healthcare connect you'll get all these forms about the patient's history and this might be an area where some people might not necessarily know to build this particular code. So let's just see

What people are clicking. Just give people a few moments to vote and it looks like it's

Very tied here. There seems to be a tie between two answers and like I said, sometimes with these cases there could be multiple answers to this. So it looks like most people are selecting either B or D and actually either could work, to be honest, both of them could be okay to bill as well, but why was B selected in this case? Well if they're kind of complex and you are kind of rostering them, you might want to choose a bit of a more higher billing code. The K131, which is the annual physical code. So if your healthcare connect patient comes in with the healthcare connect form and you see that form in their chart and it has a box on that form, it's a box that's a visual reminder to tell you to build a Q053. But sometimes the doctors don't necessarily see that that patient has that Q053, that reminder and so they miss out on the $350.

A  is correct too, but why is B a little bit more correct just because if it's a complex patient you might as well bill a K131 as part of an annual physical when you're seeing that patient. Q013 should still be in effect, but there are certain other Q codes like Q0, so you see 23, 43, but there's no Q033. Those codes are the ones that are the Q033 and the Q013, they're missing from the number order. So that's why it's two, four and five and then you don't necessarily bill the Q053 on your own. It's only if the healthcare connect form has that box on there as a reminder to you. Okay, someone said I did not know that out of basket billing will not cause negation, exactly. So when you're billing as a walk-in clinic doctor, of course you don't want to try to negate your FHO colleagues and happens very often. So if you know that some of the codes are out of basket, try to bill those so that they don't negate your FHO colleagues if possible. 

Billing Case 10: Steroid Joint Injection

Okay, scenario 10, a patient comes in for a steroid joint injection in both knees, what would you bill? So I'll let the poll show up on the screen

And with the healthcare connect, I think I saw that question somewhere up there before it just moved. Someone had asked how does one see this healthcare connect form? Usually when you're rostering patients or anytime you get a patient, the patient doesn't bring the form with them, it comes in the mail. So either your secretary gets the actual letter by fax or by physical letter you might get a huge stack of envelopes from healthcare connect and they scan it in. When you do that chart review of that patient, you'll see it there as well. So let's see what people are voting for in this particular case.

This one seems like it's an easy one for a lot of folks. A lot of people are selecting one, vast majority of people are selecting one answer and that answer is C. So this is where often people might get rejection because they bill two units of G370 when actually when you're doing the second joint, it's a different billing code. It's a G371. And then of course just want to remind you, you see these greater than caret symbols next to the billing code itself. That's just a reminder, a visual reminder for you to add on the tray fee. If it doesn't have that carrot symbol next to it, then you can't build a tray fee with it. But often missing out on tray fees or forgetting to build tray fee is one way doctors lose money. And so you want to build the tray fees to cover your overhead as well. So this is what I mean by these symbols and please take note of those symbols as well. 

Billing Case 11: WSIB

Okay, so WSIB billing is often a confusing area. You evaluate a 33-year-old typist with a history and signs of lateral epicondylitis due to work. You conduct a history and physical on this condition. They also ask you about a rash, then you prescribe a steroid cream for the rash and you prescribe steroid cream and physical therapy. What would you bill in this particular case?

So I'll give folks a few seconds to submit their vote, see what they say. Okay, so it looks like a lot of people, this one, it might be a difficult one for people. I think there are several different answers in this particular case. So let's see here. So in this particular case, the answer is A, which looks like the majority of people selected. So as you can see this is directly from the WSIB website and often people are confused by WSIB billing, they're A888. I'm actually not sure what's A888. Maybe they mean a triple A007, but specifically in this case you have a rash. So you would bill OHIP for that rash. So A007 to OHIP, but then this patient also has a second issue, which is the lateral epicondylitis. But because this is a WSIB issue, you wouldn't bill that particular issue to OHIP. You would bill that to worker compensation board. So the WCB and on your EMR you can switch it to from OHIP to WCB, and then you would also do the form eight or ask the patient about form eight and you submit that to WSIB.

Okay, so this is an area where people are often confused about you can't bill OHIP for a WSIB issue, right? So you bill the WSIB issue to WSIB and you build a rash issue to OHIP. Someone says, seems like A001. I mean yes, but A001 wasn't one of the options. So that's why out of those four options I clicked A as the option. But sure, if you want to do an A001, that's fine too. For the rash, it kind of just depends on how long you spent with the patient. If you spent a good amount of time with the patient talking about the rash, then of course bill the higher billing code.

So how do I bill WSIB? You can do that through WSIB Ontario. This website, which I have in the link before and TELUS Health. So a lot of people are saying, oh gosh, it's moving really fast. You can bill. So because you have two separate issues, one of them is an OHIP issue like the rash, one of them is a WSIB issue. So that's why those are separate. So when do you bill WSIB? It's if the patient has an injury related to work and most workplaces on Ontario subscribe to WSIB. So that way it covers their employees should they get injured on the job. So did the injury occur at work? If so, they intend to claim WSIB, then you would bill MOH with the WSIB as the insurer and complete form eight WCB is just worker compensation board. So it's the specific code on your EMR, WCB instead of OHIP. If the patient doesn't intend to claim WSIB, you would charge the patient privately because you can't bill OHIP for a work related injury. So hopefully this kind of clarifies the pathway on here. 

Billing Case 12: WSIB Follow Up

Okay, so another WSIB question. Hopefully this helps clarify things a bit more. So there's a follow-up visit for the previous patient. Yes, WSIB can be very confusing, but the more cases you do about it, then the more familiar that you get. And Form eight does have a separate pay as well. So you'll see that in the next couple of slides. So a previous patient in four weeks follow up shows no improvement and they bring in their workplace wants them to fill in the WSIB progress form. Which of these forms would you select?

So I'll let you choose an answer. Okay, so it looks like most people are selecting D as their answer and some people are selecting B. So it's kind of tied. So let's see what is the answer in this case? So in this particular case it's Form 26. So this is a progress report. So the patient actually hasn't really improved. So if the patient hasn't really improved, then that's why you would build a or choose the Form 26 instead of the FAF form. So the Form 8, so that one is when they initially come to you because they have some sort of WSIB issue that you determine is worth applying for WSIB for. So if you do it online, it pays a bit more, but if they're ready to return to work and they're feeling better, yes, then you would do the FAF form as well. So this is the billing guide specifically for WSIB because sometimes it can be a bit confusing, right?

So someone in the chat had also asked, can you also add A007 to WSIB form 26? Yes, if you've assessed them for a specific issue, yes, you can bill, I know it's not enough details provided I think this particular question is getting at this particular form where form 26 versus FAF, so that can be where it can be a bit confusing, but technically yes you can also build A007 to WCB just like in the previous question so that you can provide the information so that you can bill WCB for that particular assessment as well. 

Billing Case 13: Diabetes Visit

Okay, so let's do a little bit about diabetes as well because sometimes diabetes can be a bit confusing too, and this is a example of where two billing codes might work. In this case, let's see what people select here you have a 55-year-old roster patient. They come in for their every three months diabetes visit. This is their third visit. So let's see what people voted for here. 

So it looks like most people are selecting A and someone in the chat says K030 and the next day Q040 and that could also work as well. So that's why I put A and D. So generally what I personally do is I bill a K030 and I set myself a reminder to bill a Q040 the next day. Some people will just bill a Q040 at their fourth visit. That's totally fine as well as long as they've had three visits, then that's when the Q040 works. Someone ask why the next day, the reason why do it the next day is you have to have billed at least three K030s. So if you have those three, then the Q040 will apply. It kind of depends on when it goes through exactly someone in the chat, I think I saw they said it pays when you do it the same day if it goes through every time for me, yeah, it kind of depends because first you have to have that K030 go through to unlock the Q040, the third K030.

So as you can see here, a Q040 is eligible for payment if a physician has rendered a minimum of three K030s. So it kind of depends on when the billing goes through and someone else said mine rejects every time when done the same day. So it kind of varies across different people, different billing softwares and how quickly the K030 goes through. If the third one goes through, then yes, the Q040 will get approved the same day, but if it doesn't get processed as the third one, then the Q040 doesn't necessarily get passed. So that's why some people will bill it at the fourth visit. Some people will bill it the next day. I personally just do it the next day. 

Billing Case 14: Diabetes Phone Visit

Okay, this is another diabetes example. You see a diabetic patient for the first time over the phone to discuss their A1C medication and routine examinations. Which one would you bill

Chris Handscomb (Dr.Bill)

Dr. Steph? We've got about two or three minutes left. 

Dr. Stephanie Zhou

Two or three minutes, right, okay. Yeah. So even though I have more questions to go through some of the more nuances of billing, it looks like we have kind of reached our time for today. So maybe this will be the last question before I move on to the last slides. So as you can see, billing generates a lot of debate. There's a lot of different ways of billing and not one way might be correct, but there might be other ways that could be correct as well. So in this particular case, what did people select here I see here that the most common answer that people are selecting is A, but actually the answer here is B. And the reason why is because this is the phone visit. So the diabetes visit, which is the K030, the first visit, the K030 first visit, it has to be an in-person visit.

It can't be billed via phone. So if you let's say build K030 plus K301, it would actually get rejected. So in this particular case, that's where the virtual doesn't work. But maybe for the future visits, if you've seen the person first visit in person K030 in person, then it would work here. So, okay, let's see. 

Closing Remarks

So there's still a lot more cases that I would've wanted to go through, but because we're a bit short on time, the only thing I just wanted to touch on at the very end is there are some career advice interviews. Sometimes this session went by very, very fast because I try to cover several different cases like WSIB. Yes, you probably need a session just on WSIB and if you're in a FHO that's why I recorded a session just for FHOs because with specific practice cases, because sometimes when people are here from FHOs, from fee for service and from FHGs, there could be a bit of variation in the billing as well. But I hope the main gist of this presentation is to kind of open your eyes to some of the different nuances in billing and how in a FHO you might be a little bit different to optimize your billing compared to in a fee for service, for example, for additional questions, you can always reach out to this email, but I'll let Chris close off the session for today.

Chris Handscomb (Dr.Bill)

Thanks very much, Dr. Steph actually don't know if I've ever seen the chat move that quickly. 

Dr. Stephanie Zhou

So fast I couldn't follow because it just kept moving and moving.

Chris Handscomb (Dr.Bill)

But it means this topic is important and something that needs to be talked about. So again, thank you for going through all these cases. I know we didn't get to all the questions. If you're interested, please feel free to email the sales@dr-bill.ca address on the screen. Our team is more than happy to schedule a call and talk about different support services and billing options. I know many of our conversations revolve around this idea of auditing your billing practice and ensuring there is support available when you need it. There's 90 days to have these patient encounters billed for, so it's important to try and get them right the first time and have that support. So again, sales@dr-bill.ca more than happy to arrange a phone call.

As a reminder, sorry, this recording, it's going to be shared with all of the registered attendees both on the Dr.Bill website, and through OMD vendor spotlights. And also Brooke has posted an evaluation link within the chat, but we really want to know what you think. So thank you for taking time to fill that out quickly. It helps us build next sessions and garner feedback from this one. Then just finally again, Dr. Steph on behalf of Dr.Bill on behalf of the attendees, thank you very much for taking the time to come out and educate us on OHIP family medicine billing.

Dr. Stephanie Zhou

Sounds good, thanks Chris. And hopefully you learned a little bit of tidbits today. I know it went by really fast. You might have to review it a few times and hopefully you also learned something from your colleagues as well. I saw colleagues in the chat answering each other's questions and so hopefully you learn something from another person in the chat, a family and doctor colleague of yours as well. If you ever need to just watch recordings, you just watch the ones on YouTube too. You watch the recording of this session, it was pretty hectic because the chat moves so fast I couldn't keep up and just to see the poll, it just moved up really fast. So hopefully you learned some things today and if you're still confused, those five resources I put in the very beginning of the slide, those five resources, those will be all you need to really try to understand this. The more you iterations of it, you'll get better and better. Not just this one hour session, it's not enough for you.

Chris Handscomb (Dr.Bill)

Absolutely, and I think based on comments in the chat, we will definitely look at expanding these sessions.

Dr. Stephanie Zhou

Probably needs to be two parts because for residents, when I give this to residents, it's usually like a three hour long lecture. So it can be pretty tough to cover in one hour only.

Chris Handscomb (Dr.Bill)

Absolutely. Well, Dr. Steph, again, thank you very much. We really appreciate it.

Dr. Stephanie Zhou

Okay, sounds good. Bye everybody. Bye-bye.