Often, physicians don’t realize that mistakes in their billing can often have important consequences for other doctors’ claims. The misuse of telephone consultations is an example of this. As mentioned in the previous blog post on telephone consultations, when a phone call between physicians leads to a face-to-face assessment by the consultant physician, the telephone consultation is not payable. However, what happens if the telephone consultation is sent in by the referring physician incorrectly?
An Example with K730
Hospitalist Dr. A calls Specialist Dr. B and asks Dr. B to see his patient. Dr. A submits a K730 for a telephone consultation, which is wrong because the phone call was used to arrange Dr. B’s assessment. But, since OHIP doesn’t know the actual circumstances, they will pay the K730 to Dr. A. Now, a week later Dr. B submits her consultation using Dr. A’s billing number as the referral and what does OHIP do? Unfortunately for Dr. B, OHIP will reject her consultation because OHIP has already paid for the phone consultation.
The good news is that, with a fair amount of persistence, it will get paid properly in the end. The bad news is that it will take a long time possibly delaying payment by months.
This scenario (which happens often enough to justify this post!) highlights a couple of items. First, please submit your billings promptly. The sooner billings get to the ministry, the less these ‘first come, first serve’ issues occur. Second, take some time to become familiar with the codes you’re using and make sure you understand them, because you never know the impact that improper billing has on your colleagues.