One of the conditions required for a physician in Ontario to bill a consultation is that the patient must have been referred by a different physician. For instance, if an on-call Neurologist is asked by another physician to see a patient and provide her medical opinion, she can bill a consultation (A185). But if the physician is asked by nursing staff to see the patient, she can only bill an assessment (A183) despite engaging in a similar patient evaluation. Consultations generally pay about twice the amount of an assessment, so from a doctor’s standpoint, it makes a big difference whether the referral is coming from an MD or from some other health care professional such as a physiotherapist, social worker, or nurse.
Earlier this month, the MOH announced an important change to the Schedule of Benefits. Beginning May 1st, 2015 Nurse Practitioners can now refer patients to physicians, allowing the consulting doctor to bill a consultation. Like physicians in Ontario, nurse practitioners are also assigned six-digit provider numbers when they become qualified to practice. These OHIP billing numbers start with a number “7”, and can now be submitted along with the claim so that consultations are compensated fully.
Note: Nurse Practitioners can refer for consultations, e-consults and telephone consultations, but not for procedures.
For more information, see the MOH Info bulletin here.