Your First 90 Days of Practice in Ontario

Welcome & Acknowledgements

Good afternoon, everybody. I'm so pleased to welcome everyone here today. My name is Chris Hanscomb. I'm a senior medical billing consultant at Dr.Bill.

For those of you who may not be familiar with Dr.Bill, we're a medical billing platform designed to streamline billing so you can spend your workday focused on patients and your free time focused on living your life, not catching up on billing.

We've got the time down to bill to sixteen seconds a claim, and we're not done shaving seconds off that time quite yet. You're probably not surprised to hear that every year at Dr.Bill, we hear similar concerns from physicians entering independent practice.

The schedule of benefits is a thousand or more pages of where do I start. And physicians tell us they're concerned that miscodes, billing errors, and rejected claims will lead to a lot of hard earned income left on the table.

We also hear that many physicians haven't received even an hour of business training yet are expected to run a business on day one. That's exactly why Dr.Bill set out to produce these webinars and why I'm thrilled to get right into our main event by introducing Dr. Suzanne Strasberg. She's a family physician with thirty five years of experience, but she remembers her first ninety days like they were just yesterday. She's here to provide some foundational information in running the business side of your practice without losing your mind as well as optimizing your billing from day one. Suzanne is an outstanding leader in Canadian medicine, serving six years as board chair of the CMA. She was also a founding member of the coalition of family physicians of Ontario and the past president of the OMA.

And that's just scratching the surface. To sum it up, I'll just say you are in extremely capable hands. So without further ado, I'll give you the floor, Suzanne.

Thanks very much, Chris. Hi, everyone. I want to welcome you and thank you for taking the time to join us today.

First and foremost, I want to congratulate you. Completing your residency is a huge accomplishment.

I remember how it feels to stand where you are right now. That was a long time ago, July 1992 to be exact.

But I do remember walking out the doors of Toronto General Hospital on July 1st. I got the short stick and had to be on call overnight, on June 30th. And I had this huge sense of freedom, when I opened those doors and walked outside.

And that lasted a couple of days, and then it's like, oh my god, all of a sudden it's time to start making money, run a business, in addition to practicing medicine.

I think it's a real failure of our training programs that we don't prepare our residents and our learners for the business aspects of medicine. I went to U of T, and they taught us over and over and drilled into our head, Horner syndrome, ptosis, meiosis, and anhydrosis.

I've never seen it in my thirty five years in practice, but they did not spend one minute, teaching us about medical financial literacy.

So the realities are that you need to figure out the schedule of benefits, how to bill properly, how to avoid leaving money on the table, and all of that requires a little bit of education.

So as Chris said, I'm Suzanne Strasberg. I'm your host for today's session. I'm a comprehensive family physician.

I've held roles in health system leadership and physician advocacy for two decades, including being president of the Ontario Medical Association and chairs of the board of directors of of the Canadian Medical Association and MD Financial.

So I was supposed to be a plastic surgeon, and, I was trying to get pregnant, and I couldn't get pregnant. And my father, who is a surgeon, said to me, only do surgery if it's the only thing that'll make you happy.

Well, it's the only thing that made him happy, but lots of other things make me happy. So, I decided to, move back to Toronto. And when I decided that, a friend of mine said, there's this doctor in the doctor's lounge. He's looking for an associate.

He's a really good guy. You should join him. You'll have a full practice on day one. So I did.

I worked for a few years, and then I bought into the practice. But I didn't negotiate over hours when I joined him. I didn't negotiate over time off. The financial split, he told me, I just accepted. I didn't talk to him about third party billings. I didn't sign a contract to protect my interest. I just went in blind.

And I got really lucky because he was a really good guy, and it worked out. But I don't advise that for you.

So today, we're gonna give you some straightforward practical, guidance that I wish someone had, taught me on day one.

So here's exactly what you can expect to learn over the next forty five minutes.

We're gonna talk about making the shift from residency to practice and the critical things that you need to consider immediately, some workflow and billing habits to protect your time and prevent administrative creep, how to protect your own financial health, which is critically important, and some tips to avoid the most common claim rejections.

So without a doubt, the transition to practice is a major milestone, but I've had a lot of doctors, say to me over the years that, while their residency has prepared them for clinical practice, they were not prepared at all for the administrative and business realities that are associated with it.

Transitioning to Practice

So, transitioning to practice is a is a massive shift. And for most people, the biggest, shock is administrative.

You guys all know how to be doctors. You all learned that really well. Otherwise, you would not have graduated. It's being business people that we're not good at.

And what I want to do today is to offer some, advice based on experience and try and help you avoid the mistakes that I made. So as a physician, you need to play the long game. It's it's a long career. It's a fantastic career, but things do get tough.

And when they do get tough, just remind yourself, why did you decide to be a doctor? Was it because you wanted to help people? Was it because it's interesting work? Was it because you can reinvent yourself within the practice of medicine, or the fact that you just love lifelong learning.

What I would say is really important is stay curious about things, find the right balance between your personal and professional lives, and take advantage of all the things that medicine can offer you when they come up. So just an example, in my practice, we started out in fee for service, And then, maybe about, six or seven or eight years in, some of the primary care models were introduced, and the family health group came in, and we became a family health group. And then the family health organization was developed, and we move over to that. And then lastly, we became a family health team. And with each move, there was more financial security for myself and and my colleagues.

We were happier practicing, which made us better physicians, and that was better for our patients. And certainly, when we became a family health team and we had multidisciplinary help for our patients, that was a huge benefit to me and a really big benefit for my patients at Jane and Finch who couldn't afford many of the services that the allied health professionals provided.

Another thing that I want to say that I think is important is if you don't like something, stop doing it.

The beauty of medicine is that you can reinvent yourself. If your priorities change, your practice can change with you.

I've been a a family doc, like I said, for thirty five years. I have loved everything about it. I think it's a privilege to be a physician. I can't think of another profession where people give you their trust the way a patient gives their doctor.

It allows for lifelong learning, and you can make every day just a little bit different. In the last three three decades, I've been a comprehensive family physician. I've done shifts in the emergency room. I've been a surgical assistant. I worked as a clinical associate at SickKids.

I got involved at Cancer Care Ontario as the provincial primary care lead, and I was able to spend a significant amount of time in medical politics helping shape policy for doctors and patients in Ontario and Canada.

If I had to do it all over again, I do the exact same thing.

Now that doesn't mean that some days aren't hard. They are. But again, when those days get hard, just remember why you went into medicine and the joy that medicine brings you.

Some things that I think that are important when you start out, and really throughout your career is to is to look for a mentor. I've had mentors throughout my career, as recently as the last four years when, you know, I participated on the CMA board. You wanna find a mentor you can relate to, and it that doesn't mean it has to be someone twenty or thirty years older than you. That can be a a colleague that's just a a few years older than you who understands your area of specialty, the things you're going through, the challenges that you have, and how you like how you like to how you might like to practice, and what you're hoping to achieve in your professional and personal lives.

Don't don't be afraid to ask for advice. Don't be afraid to ask people how they deal with this contract or what they did with this difficult, situation with the patient or how they managed a certain HR issue within within their practice.

Just ask for advice. We're physicians. We're used to consulting, but we usually consult about clinical issues. It's important to to speak to people about business and administrative things that can help make your life easier as well.

Something that I wish people had definitely spoken to me about before I went into practice was around negotiations and contracts. And we're gonna spend a little bit of time on the webinar about about that today because a number of questions, have come up about it, and I get asked about it quite a bit.

First, I wanna say you do not have to blindly accept what's offered to you.

There are a lot of ways to get information now, way more than when I started in practice, and you can find out what people are being paid, what standard, just by speaking to a colleague, joining the multitude of, Facebook groups that are out there, reading blogs, and that that'll help level set things for you.

I wanna say that you are an asset.

People are looking for help.

There's a lot of demand for your services. You don't have to jump at the first thing, that you see. You can ask questions, and you can negotiate.

But once you decide you're going to move forward, make sure all the things that you've discussed and agreed upon that you get in writing.

And we're gonna go into this a little bit today, but your medical association, the OMA, for instance, can help you with things to consider before signing a contract.

You'll hear me say it a few times today, make sure that you get legal advice before you sign a contract.

Physicians often think that they can read a contract and and understand it, but you really should get legal advice to protect yourself.

Before you sign a contract, you're gonna decide, are you gonna locum?

Are you maybe gonna become an associate in an office? Do you wanna become someone's partner? Are you gonna buy a practice or, grow up from the from the ground up? You need to decide those things because while there's commonalities in all contracts, there will be specifics depending on, on what you, how you decide to move forward.

Contracts

So some of the considerations, for contracts and negotiations, first of all, around finance financial and billing structure.

You can't practice until you get a provincial license and get a billing number. I don't need to tell you that. If you don't have one already, which I'm sure most of you are in the process of trying to obtain one, you should do this well ahead of your start date because it can take quite a quite a bit of time to get it. Both, both the regulatory colleges and the, provincial governments move, move slowly.

You wanna discuss what type of payment models you think might work best for you. Are you interested in fee for service?

Maybe an alternate payment plan or a blended model like a capitated model, or maybe you think salary is best for you. There's there's pros and cons, to each of of those models. Nothing nothing is perfect, but based on the way you think that you might practice medicine and the work life balance you're looking for, you might find that, one payment model is more attractive than another.

You wanna talk about the overhead.

You need to clarify exactly how the overhead's gonna be handled. Is it gonna be a percentage split of your, of your billings for the month? Is it gonna be a flat fee? Are you gonna pay rent?

And what expenses, are those is that gonna cover? Yeah. Is it gonna cover all the staff expenses? Are they gonna do your billings for you? Will it, cover supplies for for the office and for the practice?

And and what about insurance? Are they gonna pay part of your, medical liability insurance, your CMPA? And what about other insurance, which we'll talk about in a second, that that may be required for the practice?

And then finally, you wanna you wanna know about third party payment. So, if you the person doesn't have health coverage or you're doing some work for an insurance company or you're writing a lawyer's letter, Are you able to keep all of that, or is that, subject to, overhead? What about work done outside, outside your regular, working hours?

I don't think it's very common anymore, but certainly when I, started, sometimes, the owners tried to take a split of work, that you did outside outside the office, and I would definitely not agree to that. What you do with your personal private time is your business and no one else's.

Some of the things that are really important, you want to, know about the responsibilities that you'll have and the scope of work.

So you need to clearly define the expected hours of work. If you're gonna have a patient panel, what's the size of the patient panel that they expect you to manage? What are the on call or after hours requirements?

Are there any nonclinical duties? Like, are there administrative expectations? Are you expected to teach?

Are there any other supervisory roles? And you need to make sure that that's all accurately reflected in the contract, and you need to know if there's payment for those for that. And then finally, sometimes, especially practices that are owned by corporations, they wanna have some noncompete clauses or restrictive radiuses around their around their practice. If you leave, they don't want you to set up business on the next corner. And, usually, I would advise not to sign those, but that's a consideration and something that you would have to think about and, speak with your legal adviser.

What about, vacation and other leave? You need to know how much vacation you're gonna get. Is that paid and unpaid?

Are you gonna get some CME days? What about sick leave?

You wanna know if there's crossover coverage for colleagues and for yourself.

So if you go on vacation, is someone gonna see your patients either in the office or in or after hours if you have after hours provided with your practice?

And same for you when you go away.

In terms of insurance, you're gonna need CMPA for sure.

And then there's other liability insurance that most people don't consider, especially if they're not owners of the practice. So if they're locums or if they're associates. And so liability insurance for slip and falls, you know, yeah, you need that insurance in case someone sues the office or or the practice and they name you. And what about it usually has work interruption included with it. And I just wanna say a quick, thing about that.

When I was early on in practice, we had a flood in our office, and we could not practice in that office for almost a month, and we were in fee for service.

And if I if my name had not been on the policy, I would have been out of luck, for a month. I would have not had any income coming in. But because my name was on the policy and, we had work interruption insurance, they paid me for the amount of money that I usually bill in a month, and that was really important.

And then the last thing about insurance I'll say is you you should really consider disability coverage and life insurance, but especially disability coverage. You've probably spent the last the the first twenty six to thirty years of your life, going through school and getting to the point where you are now. And if something happened, god forbid, you wanna make sure that you continue to get paid. And without disability insurance, you won't. And you wanna look for one that has an own occupation rider because if you can't work for a physician, you don't want the insurance company say, well, you can go out and work in sales or in retail. That's not what you're trained to do.

And then I would strongly suggest that at this young age, you consider, getting life insurance because the older you get, the more expensive it gets.

And then just a couple of, two quick words. Most contracts will have a termination, clause.

You wanna make sure that you also can terminate for any reason, not not just the practice or at least reasons for you to be terminated are are good and valid reasons. Most termination clauses are sixty to ninety days.

And then for people that think that they're going to be buying into a practice or starting their own practice, you'll likely be signing for a lease or other contracts related to start up, and that's a big financial obligation.

So make sure you get someone to read those leases, a lawyer who, has, experience in reading leases so that they can protect you, and make sure you have an understanding a good understanding of what you're signing for. You're also gonna need employment contracts for your staff to protect you in the event of a termination. If you've bought into a practice and they've had a staff person there for fifteen years and there's no employment contract in place, and you terminate, it can be as much as one month of salary for every year worked, and, that can be a huge financial burden on you.

I know that the Ontario Medical Association has employment contracts templates that you can use and fill out, because I have used them. And so they're available, and then, again, you can have them reviewed, by your lawyer, with all the other documents.

Next slide, please.

Reality Check

So just a a little reality check.

You can put all those things into place, love what you do, and still have some days that are tough. You can have, difficult patients. Maybe you had to deliver some really bad news to a to a young person. You can have HR issues, in your practice. You can have personal stressors in your life. You can have a ton of paperwork that's backlogged, and all of that can leave you, feeling a little burnt out. So you you need to find ways and put in strategies, to manage this, and that includes structuring your day, managing your workload, and protecting your time to sustain your career.

So there are supports for physicians in managing burnout. Dr.Bill, for instance, has a physician's guide to tackling burnout, which, is is easily available for you to read if you like. And there's there's other strategies and documents available online that are easy to find.

But before we talk about, managing burnout, I thought we'd do a quick poll. I just want you to have a look at the screen, and I'll just wait for it to come up. So what we're asking you to to vote on is, the question, what do you think is the number one contributor to physician burnout in Canada today?

So please go ahead and vote, a, b, c, or d, demanding on the job hours, excessive administrative burden, staffing shortages, or complex clinical decision making.

Okay. Perfect. So, four percent was demanding on the job hours, ninety two percent was excessive administrative burden, four percent staffing shortages, and zero percent complex clinical decision making.

So thanks thanks, Chris. So, most of you guessed b, and guess what? You guys guessed right.

In Dr.Bill's survey and in the study we did at the Canadian Medical Association, about 77% of physicians said reducing administrative burden was the top solution to help with burnout.

As the CMA board chair, we made burnout a top pillar, a major pillar in our strategic plan, and we created a committee around administrative burden that went around the country and spoke with physicians about this issue and the impact on them and the provision, of care as a result of it.

And the results were truly eye opening.

Dr.Bill also has a white paper that I'll direct you to about this, called hiding in plain sight, and it it also discusses this issue.

All the PTMAs are looking at this issue. The Canadian College of Family Practice, the Royal College is looking at it. Just a couple of, data points for you. Physicians spend an average of seven point five hours a week on nonclinical administrative tasks. That that's completely ridiculous. That's a day a week. Imagine if, we all could see patients, a day a week more, what that would do for access to care.

77% say they spend less time with patients due to their administrative burden, and 85% report doing work outside of their normal working hours. That is a huge stressor to your personal relationship, which I can tell you from personal experience is is hard enough.

Some good news, though. Burnout can be managed.

Go to the next slide.

Habit #1 - Establish a Routine

Just wanna go through a few tips, that I'd like and comments that I'd like to leave with you that, might help.

Figure out how you plan to, spend your day and protect it. Establish a routine and and then build some boundaries around it. What you wanna do is you wanna integrate your charting and your billing into your active workflow.

Don't let things pile up.

Otherwise, you're gonna get that end of day dread feeling, and it is not a nice feeling to have. For me, I always completed my charting and my billing before I moved on to the next patient.

I did the billing immediately after the encounter, and that helps prevent, from forgetting to bill certain codes or add on codes, if you leave it to the end of the day.

Something that I think is really hard for all physicians, but especially hard for physicians new in practice, is you have to learn how to say no.

People are going to ask a lot of you.

You're going to want to do a lot. You're gonna wanna build your your career. You're gonna wanna build your practice, and you're going to want to say yes. But you can't say yes to everything, and so it's really important to learn how to say no sometimes.

That's not, as I said, not easy for us to do.

Try and figure out what makes you faster.

In the last few years, there's been AI scribes making a huge difference to a lot of people's practices, templates that you can insert into the electronic medical record. I started with paper charts. We wrote all the histories, all the physicals out over and over again every day, and templates in an electronic medical record totally revolutionized the way I practiced. I have a template for every, physical exam for every system. When the patient comes in, I insert that template into the chart, and I just modify it quickly, based on the physical findings.

I'd really, encourage you to allot a part of your day to tackling third party requests such as legal letters and forms. Carve that out away from your clinical time when you're seeing patients. My personal rule was that I would do no work from home. I preferred staying a little bit later in the office so that when I went home, I was free to spend time with my family and not have to go back to work and feel stressed about having to finish stuff after my daughter went to bed.

Habit #2 - Optimize Tech

I think it's really important to, optimize your workflow and tech. And what do I mean by that? Stop moving back and forth, between your clinical care, charting, checking messages, and returning calls. Really try to maintain your focus on what you're doing so that you can be effective.

Look at what you can delegate.

So if you have a nurse in your office or you have an experienced admin assistant, they can look in your inbox, and they can take out all the normal results and file them so that when you go to your inbox, you're just looking at results that really require your clinical expertise.

You can delegate to someone to call patients about, follow-up results. Let's say someone has a low hemoglobin and you want to check their iron, you wanna check their B12, etcetera, you don't have to call them to do that. You can put the req in the chart, send a quick note to your admin assistant or your nurse or whomever else is working with you, and you can delegate that work and have them speak to them about the follow-up. Or, if you're working in a multidisciplinary team, there's things that you can delegate to that those health care providers that you don't need to do.

Definitely use your EMR functionality to set reminders, and for for other important interventions whether prevention is needed, for certain patients.

Invest time upfront to fully customize your electronic medical records to make you faster, you know, thing things like I talked about templates and macros.

AI scribes, as I said, have made a huge difference. Lot of doctors in my practice are using them. I have a colleague who's a past president of the Canadian Medical Association. She's a developmental pediatrician, and she would spend an hour to an hour and a half with a patient and their parents.

And she said that going to a scribe has changed the way she's practiced medicine. She can look at the patient, and then when they leave, the AI scribe produces the copy of the consult. If she wants a little bit more information about something, she'll say, can I have a little bit more information about that incident in grade seven? And, it'll be updated.

So if you haven't looked into them, I encourage you to do that.

One thing I never do delegate is billing. I manage all my billing. It doesn't take very long. And you'll hear me say a couple of times, and I tell people this all the time, nobody looks after your money like you do.

So all EMRs and billing platforms have a pretty seamless quick entry. I think you heard Chris say sixteen seconds. Do it immediately after the end of each patient encounter so that it gets done right, you don't forget to bill, and you don't forget to bill certain add on codes.

What I do delegate is rejected claims. I think my time spent a lot better using a platform like Dr.Bill or using an administrative staff member, who I've delegated to chase down, version codes or, look into why claims were rejected or not paid.

Habit #3 - Treat Yourself like a Patient

Next slide, please. Oh, you're there. Sorry. Last thing I wanna say is treat yourself like a patient. Physicians are notorious for, not taking care of ourselves and ignoring our own advice.

So while you would tell a patient to make sure they're sleeping well, make sure they're eating well, make sure they're exercising, and carving out personal time for themselves and their family, you need to do that for yourself.

You need to recognize if you're feeling burnt out or really stressed, recognize that and and don't get help, don't delay helping don't delay getting help. Every province has a physician help program, health pro health program. I apologize.

Ask for help. There's nothing to be embarrassed about. These are confidential programs. The one at the OMA is is truly outstanding.

It's a world leader. If you need help, ask for it. Don't don't wait till it it gets too late.

Own Your Financial Health

So now a topic that's near and dear to my heart, owning your own financial health. As doctors, we don't want to talk about money usually. We think we think about it as being dirt a little bit of a dirty subject.

I wanna say that I have always felt that wanting to earn a good income and being an empathetic and caring physician are not mutually exclusive.

We need to value what we do or others won't, and we need to own our own financial health and, keep on top of it. Otherwise, you're gonna be, leaking revenue. So I'm gonna spend a minute talking about, a common problem - underbilling.

So here's what I've observed over the years as reasons that especially new physicians underbill, but all physicians underbill. One is not yet knowing the fee schedule and not knowing what billing that you're entitled to bill for. And there is a lot to learn.

I'm not I'm not trying to belittle that. There there is a lot to learn, but it's important to pay attention to it. And if you don't understand, to to ask someone or to use a billing service that might be able to help you.

Often, new physicians underestimate the complexity of an encounter, so they underbill to be safe.

Not just new physicians. Lots of physicians rush through the billing at the end of a of a long day rather than billing, after each encounter and forget forgetting to bill some codes or forgetting to bill some patients.

Some people just don't know that there are certain routine services that are also included, whether they're flow sheets, after hours codes, special premiums that are billable separately.

You, need to pay attention to codes that are time, day, or age specific. So if you bill there for instance, there's a special premium during the day, for going to see someone, at home with a sacrifice of office hours.

But if you bill the evening code, or the weekend code, you're not gonna be paid. If you bill a code for a child between the ages of 2 and 15 and the person is 40, you're not gonna be paid. All of that rejects.

For the family doctors in the room, we're going to cover this topic in more detail, including the various primary care models and the differences between them, the subtleties between them on July 16th at at the next webinar at, at noon, and I encourage you to, sign up for that if you haven't because we'll go into detail there.

Something that I, think is important to flag for you is that the system is never going to let you know that you have underbilled. The reality is that it's attuned to catch overbilling, but, OHIP, for those of you in other provinces, the provincial billing system, government don't care if you bill for your services or not. In fact, they probably would prefer that you don't because it costs them less, less money.

Some research we did at the Canadian Medical Association showed that physicians don't bill to for up to 5% of the insured services they provide. So that's a lot of money being left on the table, and that's why you need to take ownership of your financial health.

Next slide. Thank you. So we're gonna do one live poll, again. But which of the mistakes do you think cost new, Ontario physicians the most money each year?

Our results are pretty evenly split. So missing a special visit premium is 18% of the votes. Incorrect or expired patient health card version codes, 23% of the votes.Wrong diagnostic code is 27%, and providing uninsured services, for free is 32% of the vote. So a pretty even split.

Okay. Thanks very much, Chris. So all of those are reasons that you can have revenue leak.

But, actually, the most common reason is b, and it's a version code error.

All EMRs can check for health card validity in real time, and you need to make sure that staff does this at every visit when the patient comes in. And a lot of times, they they they don't. And so this is a completely avoidable financial risk to you. So, make sure the patients present their cards, and there's just a little button on every EMR that you click, and it tells you if the health card is valid immediately.

Again, some data. Physicians can lose up to $10,000 a year just from, version code errors. And, if you get a rejected version code, you have three months in Ontario to resubmit and to make sure that you're paid. And, again, this is work you can delegate.

I don't do that. I hand that off because, again, I think my time is better served than trying to chase down a patient to get their OHIP card. Or what's possible is you can have staff - through the Ministry of Health, you can get correct version codes through a procedure. You don't even have to find the patient, and you just have to do that and then have that resubmitted. So that that that's work that, I always delegate.

So with that, I'm gonna hand back to Chris to, walk you through the top three mistakes and how to avoid them.

Top 3 Billing Mistakes and How to Avoid them

Thanks very much, Suzanne.

Okay. So mistake number one, like we've been talking about, is is around patient data. The first revenue leak happens before a patient's even seen. So if a health card version code is expiring or missing, the claim will be rejected, and it's, you know, bad data in, bad data out.

This is where automation makes a real difference. And as Suzanne suggested, having every patient health card and version code run at every encounter makes a a huge difference to ensure, rejections and errors are being reduced. Not only does this minimize rejections after the fact, it helps ensure you're paid on time, and fairly rather than having to wait. Other features like label snap allow physicians to populate patient information directly from a hospital label, eliminating any manual entry and entering health card numbers and version codes, genders, dates of birth into a platform.

Our next mistake is missed premiums.

So and, Suzanne, thank you for for talking about your routines and habits in terms of billing because that, you know, in our opinion, truly is the gold standard in terms of ensuring you're not forgetting anything. At the end of a long shift, it's it's easy to default to a basic code and and move on, when you're billing for a long list of patients that you've seen throughout the day. But that often means leaving after hours premiums or special visit premiums unclaimed that you rightfully earned. As Suzanne mentioned earlier, the system will catch overbilling. It will not catch underbilling. And, you know, I've speaking spoken to thousands of physicians over the years, and there's often a fear of overbilling. So the default becomes underbilling.

We want to ensure we find the fair compensation based on the work that you've done.

Dr.Bill has ministry rules built directly into the platform. It automates flags when a premium may apply based on the time of day, the codes you've selected, so you're more likely to capture the full value of your work.

And mistake number three is ignored rejections. So every month, you'll receive a rejection report showing what was paid, what was rejected or refused. When you're busy clinically, a lot of physicians admit they will often let rejections go, but uncovered rejections can really add up very quickly.

OHIP, has also made the deadlines far more strict. We used to have six months. Now it's three months, that claims will become considered overage or expired, except in extenuating circumstances. But, essentially, the ministry will permanently refuse to pay claims that are beyond that three month window. With Dr.Bill, you don't have to necessarily manage the back and forth yourself. On our comprehensive plan, our team of seasoned billing agents investigate, correct, and resubmit rejected claims on behalf of the physicians that work with us so nothing falls through the cracks. And back over to you, Suzanne.

Okay. Thanks, Chris. So those are the top three most common billing mishaps and some things just for you to consider as you start start your your practices and start billing on your own.

After the webinar, we're going to be sharing with everyone a toolkit with our top billing guides. One final thought before we wrap up that I wanna leave with you. You don't have to be a billing expert on day one. You need to focus on building your practice. So I highly suggest whatever you however you decide to manage your practice, think about delegating back end support so that you can free up time, see more patients, generate more income, and and reduce your stress.

So with that, Chris, I'll hand it back to you to talk about the next steps before we take some questions.

Thanks, Suzanne.

So our our goal at Dr.Bill is to make sure you never leave income on the table. Income that you have earned should not be left unpaid. So to help everyone get started risk free, Dr.Bill is offering an all, offering to all new to practice physicians three months of complimentary service. This allows you to experience our comprehensive plan and have our billing agents completely manage your claims while you focus on the the long list, of things, some of which Suzanne has gone over today about starting into practice.

Q&A

As okay. So at this point, we're going to open up the floor to Q&A.

As we've gone through the presentation, a few people have inputted questions, which, we'll get to. First, we're gonna take a quick look at some of the questions that were, submitted prior, to the presentation presentation starting.

So, Suzanne, maybe I can read those out, and we can, take a look at those first. Sure.

Okay. So the first one is I'm planning to start a family practice, but I'm feeling overwhelmed by all the different payment models. I'm hearing about FHOs, Family Health Networks, groups, now FHO+. Is there a simple way to start thinking about which model suits my lifestyle, or should I just focus on surviving the first few weeks? What are your thoughts on that?

So, well, my my first thought is you should be joining us, next week for the webinar because we're gonna go into detail about the, similarities and differences between between the models.

But I would just say something like, the Family Health Group, which is, the most common, fee for service model in Ontario for for docs, practicing in in comprehensive family medicine has a lot of fee for service and a little bit of capitation. And then the FHO or FHO+ model is the most common model in Ontario for for doctors, practicing in what we call a blended model, and that's quite a bit of capitation. That means, your money comes every month, age and sex adjusted based on the, size of your roster, and there's and then there's, much less fee for service. So it depends if you are more interested in a fee for service model or more a capitation model, and we're gonna go into the pros and cons of all of that next week.

Perfect. Thanks, Suzanne. And, you know, we're gonna go through the different frameworks to help people try to evaluate which path best aligns with their their goals, in practice in both, practice and lifestyle. So thanks for the question, and and we'll definitely register for next week. And there was a question about how to register for next week's webinar, which was answered in the Q&A. So there's registration link has been provided in the Q&A for everyone to take a look at that, and register.

And I also believe, Chris, that everyone's gonna get an email at the end of a follow-up email at the end of this, webinar, and you can register through the link in the email if you haven't done so already.

Yes. Perfect, Suzanne. Yeah. And there'll be, the recording of the webinar will also be, released to everyone who's registered, along with the toolkit that Suzanne mentioned, a little bit earlier.

Okay. There's a Suzanne, there's a question in here about, reading contracts. I know you did spend quite a bit of time going through some of the important points.

The question was relatively general. I don't if there's anything else you wanna add, or we can move on to the next one.

I think that people should take away, the, larger key points that I provided. They can always speak to their medical professional organizations, or I believe PARO has a document as well.

And but definitely, definitely get legal advice.

Yeah. Absolutely. And and when thinking about contracts, it's what are the non-negotiables versus what are the negotiables. It's really important to understand that, as you think about your lifestyle, and practice.

Okay. So we have a question here a little more specific.

Can I bill internal medicine codes before I'm a registered allergist or another type of specialist? Suzanne, I'll let you start. If if you feel you wanna kick it over to Veronica at all, please feel free to do so.

Okay. So I'll give, very quickly, I'll give my opinion. And then if Veronica thinks there's something to add or I've been incorrect, I'll ask her to add to it.

It depends how you're, registered with the CPSO. So if you're registered with the CPSO, as an internal medicine specialist and then you're going on to become an allergist or a cardiologist, gastroenterologist, it doesn't matter, you and you have a billing number as an internal medicine specialist, you can bill internal medicine codes.

And then when you become a a subspecialist, you can bill those subspecialist, specific codes once you're recognized by the by your regulatory college. Veronica?

No. That about covers it. One important point that I do like to highlight on that topic, just because it's not generally discussed anywhere else, is that once the CPSO does have you registered with a specialty, they do not communicate that information to OHIP. It's on the physician to make those communications themselves.

So we very often have new physicians signing up with us. They're submitting their codes. The codes are coming back as not eligible for that specialty. And nine out of ten times, it's gonna be because the specialty hasn't been registered with OHIP, which very commonly the assumption is that CPSO is gonna do that on the physician's behalf, but they don't.

So it's just another, small area where the physician needs to advocate for themselves in an administrative capacity to communicate that information that safely assumed to be done for them, but it's not.

I think that's a really, really good point, just quickly to make for people. For instance, if you're doing a locum and, the lead physician or whomever is submitting your locum papers to, government if you're in primary care, and you haven't heard anything in a few weeks, follow-up. Because we just had something fall through the cracks. If there's something wrong on the locum papers, you haven't completed it properly, they don't tell you.

They don't care. So make sure that you follow that up. Again, it's a little bit like your money.

It it is your money because if your if your papers aren't ready to start on time, you can't you can't start you can't start working. You're gonna be losing days. So don't don't think that governments are going gonna take care of you. They're not.

You gotta follow this stuff up.

It's certainly one of the when new to practice physicians are coming in and they don't have or there is the expectation that their subspecialty will automatically be added. The the result of it is, you know, days and weeks worth of claims being submitted and all of them being rejected. And then there's the process of going back and and, doing a remittance advice inquiry through the ministry. It becomes more of an administrative burden to actually get paid for those claims.

Depending on the company or platform you're using, like, with Dr.Bill Comprehensive, I know Veronica's done this with with a number of physicians, but actually going through the process of going back to the ministry, what happened. And, you know, we go to bat for our customers to to plead our case and why these claims should be paid, but can't stress that enough. We we see it time and time again.

Okay. So the the next question is relatively general, but but I'll throw it to the group, for comments. But just discussing premiums and how to optimize billing overall. Any, you know, key takeaways or or or points you wanna, share with the group?

So I saw there were a couple of premium questions, and, I have to give a bit of a general answer because the premiums were, some are common, but some are are different depending on your specialty. So first of all, how to optimize? Bill them when you do them. That's gonna be the same for for anything I speak about with with respect to preventing revenue leak.

Try and find out and understand, what premiums are available. First of all, this section of general and family practice, I'm sure you got Dr.Bill has commonly billed codes, and they include the premiums there so you can familiarize yourself with it. But there's travel premiums if you have to travel for a reason. And there's some during the day, and they have certain restrictions. There's some after five o'clock. There's some after midnight or on the weekends.

You know, I know there's a lot of primary care doctors from Ontario here, or family doctors. You know, there's there's premiums if you see babies in in a FHO or in a FHN, if they're less than a year, so you gotta remember to bill that. There's premiums and add ons for completing diabetes or, congestive heart failure, flow sheets. Some things that are common to, all specialties are there's tray fees for doing procedures and for doing PAPs.

Whether you do an injection, you know, of a joint or anything else, you remove a foreign body, all procedures have special codes and add ons, that you can, use in addition to the office visit. So you have to familiarize yourself a little bit with the schedule of benefits for your specialty. And if you're in primary care, a little bit for your model because there's some, billing codes that are different, based on, what model you choose to practice in.

And we often stress to new to practice physicians the importance of building your resources roster as you're going into practice. A quick plug for Dr.Bill, the team at Dr.Bill who creates our content, which is all available for free on our website. We have countless summaries and guides, premium guides that are specific to different areas of medicine.

So rather than, you know, digging back into the thousand page schedule of benefits, find the resources that really summarize how you can bill effectively. And if it means in the first few weeks of practice, taking that extra time to to learn how to bill effectively and learn what premiums are available for you, it will impact you for the rest of your career. So taking that time early on could not be more important.

It's a small investment in your financial future.

Chris, we got about four more minutes, so maybe we can take two questions?

Okay.

So we'll go to to to the last slide and wrap up.

Okay. Perfect. So what what to do if a patient never renews their health card? Is there a way to reclaim any lost income?

So, if the patient comes in and they don't have a proper version code, like I said, that shouldn't happen because you should be able to tell in real time that they don't have a proper code, and then you don't have to see them unless it's an emergency. So in often in the emergency room.

Or or your staff can call, the Ministry of Health or or use the online, to get to get the proper version code. But if their their card is canceled for some reason, you you can direct them to to OHIP. If you can't get a proper version code, then, no, you can't you can't reclaim it. Sometimes I'll just give you a hint of what I've said to patients.

Sometimes patients come in and they're upset because their health card isn't valid, and I've told them I can't see them. And I just say to them, listen. This is how I get paid. If you go to the store without money, they're not gonna give you milk.

And I don't I don't think you should be ashamed or or feel, you know, I say it in a nice way, but I you know, this is how you get paid. You're not in the business of, providing care for free unless you want to provide care for free.

You still and and sometimes I do. But you still need to be able to pay your staff and pay your rent and pay your overhead, and so you need a valid health card from the patient.

Thanks, Suzanne. Okay. One more to wrap us up.

If we're family medicine trained and will be primarily working in the emergency department, do we have to clarify this to the ministry? And if so, what is the contact info? Maybe we'll focus on the first part of the question.

I don't think you you'd you'd still be using a 00 billing number.

So, I don't put there's no special, CCFPEM billing number for the CPSO. You would just bill the, emerg, codes while you were working in emerg, just like someone who's, Royal College trained, but they would have a different it would be different at the CPSO. You you would still have a GP billing number, which would be 00.

Perfect. Thanks, Suzanne. That, yeah, that wraps up the Q&A. So if you have some closing remarks, you wanna share?

Sure. So, thank you, everyone. I hope that you found this useful.

Two quick housekeeping items before we we wrap up. Keep an eye on your inbox. We'll be sending everyone who registered for this, as Chris said, a follow-up email. There'll be a link to today's recording.

Feel free to share it with your colleagues if you think that it it, will help them. You'll also get, the complete billing guide tool kit and a short feedback survey. So please let me know how I did. If I stunk at something, please let me know so that I can do a better job next time.

I know that you're busy and you got a lot of stuff to do, and it's nice outside. But if you could take a second to fill the survey out, we'll continue to tailor any content to what you need. And then if you're entering primary care, please sign up for the second part next week, July 16th, from noon to one o'clock. We'll break down the complexities of the primary care models in Ontario and answer your questions that you have in more detail then.

So thanks very much for joining. We really appreciate your time. Congratulations, and good luck to you in starting out. It's a a wonderful career, and I love it, and hope you do too.

Take care. Bye bye.