PGY1 Lecture: Intro to Family Medicine Billing in Ontario (Pt 1 of 2)
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- čas přidán 15. 07. 2024
- 2024 UPDATED VERSION - Watch Here: • Intro to Family Medici...
Lecture recording for the University of Toronto Family Medicine PGY-1 residents. This lecture goes over the basics of Family Medicine billing in Ontario and includes some resources and practice questions for the beginner resident to start familiarizing themselves with the basic billing codes.
𝗧𝗼𝗽𝗶𝗰𝘀 𝗖𝗼𝘃𝗲𝗿𝗲𝗱:
0:00 - Intro
1:29 - Why Learn Billing in Residency?
7:30 - 3 Billing Habits to start in PGY-1
11:36 - Main Billing Resources
14:21 - EMRs
17:31 - High Yield Billing Codes
28:53 - Practice Questions
**UPDATE March 30, 2022: The OMA Ratified the PPSA which impacts virtual billing & primary care models. Here is the new billing guide: sgfp.ca/rails/active_storage/...
**UPDATE 19:57 - Dec 1, 2022, K080/1/2/3 have expired. Please review the OHIP Bulletin on the updated virtual codes:
www.health.gov.on.ca/en/pro/p...
𝗥𝗲𝘀𝗼𝘂𝗿𝗰𝗲𝘀:
1) PGY-2 Billing Lecture: • PGY2 Lecture: Family ...
2) FHO Family Medicine Billing Lecture (Pt 1): • Family Medicine Billin...
3) FHO Family Medicine Billing Practice Cases (Pt 2): • Family Medicine Billin...
4) Income Stabilization & New Grad Entry Program (NGEP) (Pt 3): • Income Stabilization &...
5) From Resident to Staff Doctor: Job Search, Starting Practice, Getting Paid: • FROM RESIDENT TO STAFF...
6) How do Doctors Get Paid?: • How Do Doctors Get Pai...
7) FHO Billing Made Simple: • Family Medicine Billin...
𝗗𝗶𝘀𝗰𝗹𝗼𝘀𝘂𝗿𝗲𝘀:
There are no conflicts of interest to disclose. These slides are for education purposes only. Any information, views, and opinions expressed are solely those of the presenter and are not a substitute for financial advice specific to your personal situation.
The OMA and CMA (Joule) have made every effort to ensure that the examples presented in this document represent “best practice” billing.
All physicians must personally read their MOHLTC fee schedule preamble and be responsible for meeting all criteria for the appropriate billing of the services they provide.
When in doubt consult your MOHLTC advisors.
#FamilyMedicine #FamilyDoctor #Billing
This is such a needed lecture series! Thank you for putting this together!
𝗧𝗼𝗽𝗶𝗰𝘀 𝗖𝗼𝘃𝗲𝗿𝗲𝗱:
0:00 - Intro
1:29 - Why Learn Billing in Residency?
7:30 - 3 Billing Habits to start in PGY-1
11:36 - Main Billing Resources
14:21 - EMRs
17:31 - High Yield Billing Codes
28:53 - Practice Questions
**UPDATE March 30, 2022: The OMA Ratified the PPSA which impacts virtual billing & primary care models. Here is the new Billing Guide: sgfp.ca/rails/active_storage/blobs/proxy/eyJfcmFpbHMiOnsibWVzc2FnZSI6IkJBaHBBbDRFIiwiZXhwIjpudWxsLCJwdXIiOiJibG9iX2lkIn19--a86bf4480d7fefbed6172fa1e1bc4751b516cec2/SGFP%20Billing%20Guide%20APRIL%202023%2002_May_2023.pdf
19:57 - **UPDATE Dec 1, 2022, K080/1/2/3 have expired. Please review the OHIP Bulletin on the updated virtual codes:
www.health.gov.on.ca/en/pro/programs/ohip/bulletins/redux/bul221203.aspx
𝗥𝗲𝘀𝗼𝘂𝗿𝗰𝗲𝘀:
1) PGY-2 Billing Lecture: czcams.com/video/P80tU_FIF3Y/video.html
2) From Resident to Staff Doctor: Job Search, Starting Practice, Getting Paid: czcams.com/video/CuDsEY2C_OU/video.html
3) How do Doctors Get Paid?: czcams.com/video/X5uOkB0BuW0/video.html
For personal questions or if you’re an instructor who would like to access my slides, message me on Instagram: instagram.com/breakingbaddebt/ or find my email on the About page of my channel.
This was a wonderful presentation and super helpful! It's a must-view for all residents! Thank you for putting this together!
Thank you for the support!
19:57 **UPDATE 2023 - NEW SGFP Billing Guide: sgfp.ca/rails/active_storage/blobs/proxy/eyJfcmFpbHMiOnsibWVzc2FnZSI6IkJBaHBBbDRFIiwiZXhwIjpudWxsLCJwdXIiOiJibG9iX2lkIn19--a86bf4480d7fefbed6172fa1e1bc4751b516cec2/SGFP%20Billing%20Guide%20APRIL%202023%2002_May_2023.pdf
Hi Dr. Steph thank you for the lecture again. I have a question abt diagnostic codes. I see some service codes such as K022 clearly require a diagnostic code 042 for the billing to go through. But for common codes like A007 can I leave the diagnostic blank? For example some pt require 10+ follow-ups in a year such as depression or HIV-infected, do I have to put in the same diagnostic code (311 or 042) every time I follow up (10 minutes) with them and bill A007?
Yes I usually get into the habit of putting in a diagnostic code because depending on if you’re in a PEM some billing codes give you a premium if you bill a certain number of the diagnostic code. For example, if I have seen 5 patients with schizophrenia and I billed K005, Q021 with diagnostic code 295, it indicates to the system how many of this diagnosis I’ve seen to collect the premium. It also allows me to search in the EMR how many times I’ve seen someone for a specific diagnosis for billing A003 for instance.
@@BreakingBadDebt Thank you for the quick reply. I did not understand the last sentence. Do you mean I should track my diagnosis codes because if I billed A007 with 311 ten times in a year for a 20 years old patient. The next year when I do annual assessment I can easily find the 311 diagnostic code to bill A003 as suppose to K131 which pays less? In this video you mentioned working in addition clinic. I'm not familiar with billing in that setting but if a patient visits you on a weekly basis, could you leave their diagnostic code bank when billing repetitive A001/007? Or do you use the same diagnostic code every time?
@@tonyssheep Hi Tony, for A003s, it can only be billed once per patient diagnosis per year so if I see a patient for chest pain and I do a full examination, I'll bill the A003 with the chest pain diagnostic code 785. Now if that patient comes back for chest pain again, I cannot bill the A003 with the same chest pain again, I would have to bill A004 with diagnostic code 785. This is why I keep track of the diagnostic codes.
Generally speaking, I always try to include a diagnostic code. If I can't think of or there is no available diagnosis for a pt who comes in with a vague issue/multiple issues, I'll go with diagnostic code 799. I don't usually bill w/o the diagnostic code, but once when I forgot to add it, my billing software didn't let me submit the billing.
Thank you for your video. Quick question about billing for a consult in which you discuss multiple issues (>=3) ; am I correct in thinking this is eligible for the A003 code?
The A003 code is a general assessment code where you conduct a full history (medical, family, social etc) around 1 issue and examine at least 2+ areas. It’s not used unfortunately when discussing 3 smaller issues that aren’t connected. Now if you’ve been referred that patient and you’re seeing them as a consultant, you might want to consider the A005 if you’ve spent minimum 50min with the patient.
Very good except for 1 error. You said that k087/k088/k089 are for uninsured pt telephone visit - not true. MOH states they are for uninsured pt visit either by video/telephone/IN PERSON
Thanks for pointing that out! It was the K080/81/82 that is tele or video only. I have linked the MOH bulletin below for viewer reference:
K080/81/82: www.health.gov.on.ca/en/pro/programs/ohip/bulletins/4000/bul4745.aspx
K087/88/89: www.health.gov.on.ca/en/pro/programs/ohip/bulletins/4000/bul4756.aspx
@@BreakingBadDebt K087: minor assessment of an uninsured patient provided in-person or by telephone or video or advice or information provided in-person or by telephone or video to an uninsured patient’s representative regarding health maintenance, diagnosis, treatment and/or prognosis-$23.75
e.g. you saw it says provided in-person or by tel/video
gee, what a pain. any chance to delegate billing to admin staff?
Yes, some clinics do have a billing manager but at the end of the day, billing managers are not physicians themselves so unless the codes are straightforward, they can bill it for you but they might miss out on certain codes if they haven't seen the patient themselves. The way most physicians do it is to write in the billing codes themselves but the billing manager submits it or fixes rejected codes.
Also the PAP smear tray fee is NOT E431 - its E430
Thanks! Can you tell me the time stamp where it says E431? I'm looking at 31:22 where it says E430
@@BreakingBadDebt At 24:48 it says on-screen in bottom-Rt "Tray fee (E431)" when it's supposed to be E430 for pap tray fee
@@darthvader1251 Good catch! I will make the change in the slides and see if I can do a pop up on the screen with the correction- thanks again!
so i just checked with OHIP... sadfully and as usual they fail doctors ...now they said they dont use codes for Bipolar or Schizophrenia any more...so no need to bill these codes...
such a terrible thing..
Wow really? Do you have the OHIP bulletin that says the Q020/Q021 codes are being removed? I remember billing these codes back in October 2021 with diagnostic code 295 & 296 for my rostered patients and they were paid out for the next month. These codes are specifically for patients in a PEM (FHO, FHG, FHN models)