An ounce of prevention is worth a pound of cure…
Our primary task as billing specialists for physicians in Ontario is to process claims with a keen and critical eye. We review, interpret, correct and keep track of our physicians’ billing habits, continually looking for potential errors, missing information, and claims that fall outside of normal billing parameters. In addition, we constantly work with our physicians to keep their claims in line with the Schedule of Benefits, using concise communication and educational tools to facilitate the billing process.
A few years ago, a new internist signed on and it became apparent almost immediately that she was billing a lot of telephone consultation codes – far more than our other internists with similar workflows. We mentioned our observation to the doctor and reviewed the payment rules. It turned out our doctor wasn’t aware that telephone consultation codes could not be billed when arranging a patient transfer. Without our support, how long would the physician have been billing incorrectly? How long before the ministry noticed and contacted her?
Over 25 years of experience in a multitude of specialties gives our team of billing specialists a broad perspective that individual billing agents or physicians may lack. With this experience we are quick to recognize atypical billing patterns, correct errors, and notify our doctors about potential issues before the claims have been submitted to the Ministry of Health. In the world of OHIP billing, preventing problems is much more efficient than solving them, and the key to prevention is identifying problems prior to submission.
What we can learn from one Doctor’s story
To refer back to the story of Dr. Nkut, had JCL handled this physician’s OHIP billing, we would have noticed immediately that his billing patterns were likely to pose a problem. We would have pointed out the OHIP billing rules regarding time-based counseling codes and advised him to reconsider. To further educate him, we would then have sent him applicable sections of the Schedule of Benefits to review so he would become more knowledgeable about his billing. Dr. Nkut’s audit was preventable, had he worked with a team of billing experts.