Physicians in Ontario are paid fee-for-service, based on a tome called the Schedule of Benefits. The sheer number of codes is mind boggling, and it takes expertise to tie the various sections of the Schedule together into a comprehensive picture for each specialist’s unique practice.
With the current climate of clawbacks, healthcare cuts, and physicians without a contract since March 2015, every claim counts. Doctors are being docked 4.45% off each monthly payment with no recourse. If ever there was a time to take a closer look at where you might be losing out on OHIP income, it’s now.
Missed OHIP Billing Opportunities
We’ve had clients come on board at various times in their careers. New physicians need more guidance in understanding and applying the Schedule to their billing, but more seasoned physicians used to billing in a certain way don’t re-evaluate their options. This can be quite costly. Let’s have a look at what can happen when you add billing codes.
Internal Medicine & Hospital Specialists
Each speciality has a section in the Schedule describing the codes specific to their billing. But there are a number of billing codes listed in other sections that are also available to specialists such as Cardiologists, Respirologists and Internal Medicine Specialists. We’ve advised many of our clients on just which additional billing codes might fit their work, and how to bill them correctly. One of our clients gained an extra $2600 per year for one premium code!
Examples of extra codes for Hospital Specialists
Family Interviews: K002 $62.75 per half hour unit – Interview with relatives for treatment decisions
Counselling: K013 $62.75 per half hour unit – Individual counselling code for all specialties
Forms : K050 $100.00 – Health Status Report
Psychiatry
In our series Inside Psychiatry Billing, we often mention that Psychiatry billing has numerous options for OHIP code combinations and add-ons. When new Psychiatrists come on board, we analyze their billing patterns over time, and we recommend additional codes. Groups and individual Psychiatrists with the benefit of our expert eye on their billing have seen an average increase of 8.47% in annual income. 
Example add-on code for Psychiatrists
Psychiatric consultation extension: K630 $105.10 per half hour unit – can be added to any consultation code, see our blog for more.
Surgery
In our experience with surgery billing, we’ve found that Surgeons are very focused on their procedure codes, but often miss out on revenue from less lucrative visit codes and premiums. Our data from 2016 shows just how much those codes are worth.
Example of add-ons for Surgeons
Surgeons are often the MRP for their patients, and as such are eligible for the E083 30% premium on daily visits, as well as the E082 30% admission premium on ER consults.
Catching missed billing opportunities takes a trained eye, time, and in-depth knowledge of the Schedule of Benefits. Though it’s time consuming, every Physician should take the time to review their billing from time to time themselves, or with their billing agent. The benefits are obvious.
Our specialists appreciate the increases in income they realize with JCL.
We appreciate the chance to apply our expertise.