𝗧𝗼𝗽𝗶𝗰𝘀 𝗖𝗼𝘃𝗲𝗿𝗲𝗱: 0:00 - Intro 3:43 - Premiums & Modifiers 11:06 - Dealing with Rejected Billings 13:43 - Uninsured Billing 17:16 - WSIB Billing 20:36 - Practice Cases *Correction to 12:54 - Health Number Release Service Phone is: 1-888-360-7530 33:06 - E409 is a typo in the SGFP document, should say 1700-2400 for the premium. **UPDATE 2023: NEW SGFP BILLING GUIDE: sgfp.ca/rails/active_storage/blobs/proxy/eyJfcmFpbHMiOnsibWVzc2FnZSI6IkJBaHBBbDRFIiwiZXhwIjpudWxsLCJwdXIiOiJibG9iX2lkIn19--a86bf4480d7fefbed6172fa1e1bc4751b516cec2/SGFP%20Billing%20Guide%20APRIL%202023%2002_May_2023.pdf 𝗥𝗲𝘀𝗼𝘂𝗿𝗰𝗲𝘀: 1) PGY-1 Billing Lecture: czcams.com/video/AveW_LYtqT8/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/breakingbad... or find my email on the About page of my channel.
Thank you so much for these lectures dr. Steph. I have a question on CCM practice model. I have non-clinical commitments during weekdays so I will only see pts on weekends. Does this mean I can bill 30% premium with Q016 for all my CCM patients? Thanks.
Hello Thanks for lovely video I am keen and many like me are struggling to find info about following topics 1. Place to access uptodated guidelines of Canadian practise - for example in UK we have GPNotebook - complete summary of NICE guidelines ... any similar website or application for new IMGS trained outside canada 2. How the ofamily medicine system or health care system works - here GP assessment if needed A&E - walkin centre - A&E hospitals etc ., 3. How to prepare for mccqe part 1 - tips and resources to follow 4. How to select a work place Many Regards Dr AAA UK - GP trainee
Hi Aleem, For 1) I like using www.fmlearner.com/ for family medicine CCFP exam review topics and the Centre for Effective Practice tools cep.health/tools/ 2) I suggest you check out this video for more info on the practice settings that GPs work in. czcams.com/video/X5uOkB0BuW0/video.html 3) MCCQE1: That's a big topic to post about in the comments but most CMGs will use UWorld and @CanadaQbank (they have a CZcams channel that you can check out as well) 4) When you're in residency, make sure you do electives in different settings (academic, community and rural) to help you determine which work settings you would enjoy working in!
Hi Dr. Steph, I have a few billing questions. 1. Special premiums in a PEM (e.g. LTC, home visits etc). Do these patients have to be rostered to you or can they be patients you see outside of your regular FM practice i.e. a side gig? 2. My understanding is that G365 cannot be billed with A003 but K131/132 is okay? 3. I have applied to MOH to join a FHG but it hasn't been approved yet. Do I bill tracking/exclusion codes only after I officially join the FHG (and bill Q200A)? Or do I have to go back and bill the tracking codes afterwards? 4. For patients who had paps within their last 3 years that were done by their previous FMD, can I still bill the tracking code even though it wasn't me who did it? Thank you!
Hi btrcyyl, here are my answers (if others reading this have additional input, feel free to leave a comment): 1) If you're working in a Patient Enrollment Model (PEM), you can bill the special visit premiums regardless of whether the patient is rostered to you or not. For example, even though I do part-time family practice in a FHG, I am called for addiction consults at the hospital. I can bill for the special premiums even though those addiction patients are not rostered to me. 2) A003+G365: Based on the OHIP bulletin, the A003 already includes doing a pap smear so the G365 would be rejected as it would be duplicate. G365 can be billed with K131/132 (I frequently bill this when I do paps at the annual physical). Source: www.health.gov.on.ca/en/pro/programs/ohip/bulletins/4314/bul4314d.aspx 3) Yes, those Q codes are for enrolled patients only after you've been approved to join the FHG and start enrolling patients to your roster. 4) If the patients are up to date on their pap and was done by another doctor, I would check my Screening Activity Report (SAR) to see if they're marked off as 'no screening required' or 'action overdue'. This is a centralized system, so if they've already done the screen, it would be recorded here. If you don't have an account, I would suggest you get one! Link: www.cancercareontario.ca/en/guidelines-advice/treatment-modality/primary-care/screening-activity-report
@@BreakingBadDebt Thank you Dr. Steph! I don't remember from where, but I do remember you talked about keeping track of your billings on a separate spreadsheet in addition to the billing software. Would you mind sharing how you do that? Like do you do it per patient encounter (like every healthcard number and every code) or per day? Then do you manually reconcile each item as it comes up on your RA? Thanks so much!
@@btrcyyl7393 Yes, I kept track of OHIP numbers and billed retroactively after I got my billing number. The spreadsheet can be found in the pinned comment of this video: czcams.com/video/CuDsEY2C_OU/video.html
Hi Dr.Steph, thank you for your informative video. Regarding WSIB billing (20:20), if a patient comes in for a workplace injury, but if the workplace is not registered with WSIB or if the patient doesn't know, can we still bill OHIP? or is that uninsured service?
Hi Shawn, it's good that you asked this b/c that's a really common question asked by students in lecture. If the injury occurred at the workplace you can't bill OHIP as it's not covered by OHIP and is considered fraud. If their Employer is not registered with WSIB, you can still submit the Form 8 which means you can still get paid for the form completion, even when "coverage is not indicated." Source: shorturl.at/eAOPQ If a patient doesn't consent to you reporting to WSIB nor do they want to make a claim with WSIB, you still can't bill OHIP for the service rendered. So the patient would have to pay out of pocket or you would not get paid for the medical services rendered. Source: web.ncf.ca/ex864/schedule/docs/ThirdPartyGuide.pdf Hope this helps!
I believe you mentioned in previous videos that community EMRs have integrated billing software (plugins?)... Any automatisation assistance for that matter? I mean, does soft helps to generate codes or it is just for submission only?
Yes community EMRs do have billing software integrated in it that is not a plugin. Tbh I haven't encountered very much automatisation for it except for the case of group billing, so if you have a group of patients with all the same code, there's a way for most EMRs to bill as a group. However, this may not be realistic for most doctors if each patient they see are different diagnoses or you spend different amount of time with the patient for time-based codes.
Correction to 12:54 - Health Number Release Service Phone is: 1-888-360-7530 33:06 - E409 is a typo in the SGFP document, should say 1700-2400 for the premium.
Yes I think it should be 1700-2400 come to think of it, that must be an error in the SGFP when they printed it as 0500-1200 so the question writer from the OMA put 7am in the question. I think that's why when I saw that, I paused a bit b/c it looked a bit off to me too. It should probably say 7pm did a delivery. E409 isn't just an OB code, it's also used for fam doc procedures after 5pm. Regardless, even with this change I think the answer is still D because you did surgical assist for the C/S at 9pm which is within the premium hours. - Also just to write it here, there are some SGFP codes that may have been misprints that I've started to notice when working on this lecture. In addition to that one, there's the Influenza Vaccine Enhancement Fee which was printed as Q012A but should be Q102A (pg 6 of SGFP document)
And if the A888 applies to all walk in clinic visits, how do FHO doctors lose their access bonus at all? i.e. Assuming walk in clinics don't bill the A007 (and use A888 instead), how would a FHO doctor lose their access bonus?
@@JW-ws4op Hi JW, for the A888 it applies for all ER equivalents (Urgent Care, Walk Ins, Extended Hours clinics) in which patients walk in without an appointment. It applies for services provided on Saturday, Sunday or Holiday. Let's say you work on a weekend or evening in a Patient Enrollment Model (PEM) then you get to add on that Q012 bonus for your rostered pt walk ins but not if you're in a FFS walk in. FFS model docs can't bill those bonus Q012/16 codes. For the reason why billing A888 doesn't cause FHO docs to lose their access bonus, it's because A888 is out of basket. In basket codes like A007 is Expected standard of care a FHO doc is supposed to provide, so when they're not available to provide it and a pt goes to a Walk In instead, and the Walk In Doc bills the A007 - this billing is taken out of the FHO doc's Access Bonus. Here's a link to the OMA Reference Guide for more info: doctorcare.ca/wp-content/uploads/2017/05/QuickReferenceGuide-A888_EDEquivalent1.pdf?fbclid=IwAR0a1sBalTOYYL33-Zq4KayVc8oWRaZdNEnPvX-GkM7E1vA2nDza0Yj-xDk
@@BreakingBadDebt I see. I think my question was basically: Why would a walk in doctor ever bill A007 instead of A888? And so, it seems that the A888 can only be billed on weekends or holidays, and a walk-in clinic on weekdays would have to bill an A007 instead.
@@JW-ws4opYup, you got it. A Walk In Doc working FFS would bill A888 only if they're working weekends and holidays and all other times they would be billing A007. There's really no financial difference for a FFS doc, it's just out of courtesy for our FHO colleagues.
Thank you Dr Steph, I recently moved over from Australia to work and your lectures have been a great help!
Glad it's helpful! Thanks for watching!
𝗧𝗼𝗽𝗶𝗰𝘀 𝗖𝗼𝘃𝗲𝗿𝗲𝗱:
0:00 - Intro
3:43 - Premiums & Modifiers
11:06 - Dealing with Rejected Billings
13:43 - Uninsured Billing
17:16 - WSIB Billing
20:36 - Practice Cases
*Correction to 12:54 - Health Number Release Service Phone is: 1-888-360-7530
33:06 - E409 is a typo in the SGFP document, should say 1700-2400 for the premium.
**UPDATE 2023: NEW SGFP BILLING GUIDE: sgfp.ca/rails/active_storage/blobs/proxy/eyJfcmFpbHMiOnsibWVzc2FnZSI6IkJBaHBBbDRFIiwiZXhwIjpudWxsLCJwdXIiOiJibG9iX2lkIn19--a86bf4480d7fefbed6172fa1e1bc4751b516cec2/SGFP%20Billing%20Guide%20APRIL%202023%2002_May_2023.pdf
𝗥𝗲𝘀𝗼𝘂𝗿𝗰𝗲𝘀:
1) PGY-1 Billing Lecture: czcams.com/video/AveW_LYtqT8/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/breakingbad... or find my email on the About page of my channel.
Can a family physician bill for ear flushing (G420 in addition to A007)? Some say it is a third party and the patient has to pay.
Thank you so much for these lectures dr. Steph. I have a question on CCM practice model. I have non-clinical commitments during weekdays so I will only see pts on weekends. Does this mean I can bill 30% premium with Q016 for all my CCM patients? Thanks.
Yes as long as those patients are rostered to you, you can bill the evening and weekend bonus.
@@BreakingBadDebt thank u for the quick reply. These r super useful information for my setup.
Hello
Thanks for lovely video
I am keen and many like me are struggling to find info about following topics
1. Place to access uptodated guidelines of Canadian practise - for example in UK we have GPNotebook - complete summary of NICE guidelines ... any similar website or application for new IMGS trained outside canada
2. How the ofamily medicine system or health care system works - here GP assessment if needed A&E - walkin centre - A&E hospitals etc .,
3. How to prepare for mccqe part 1 - tips and resources to follow
4. How to select a work place
Many Regards
Dr AAA
UK - GP trainee
Hi Aleem,
For 1) I like using www.fmlearner.com/ for family medicine CCFP exam review topics and the Centre for Effective Practice tools cep.health/tools/
2) I suggest you check out this video for more info on the practice settings that GPs work in. czcams.com/video/X5uOkB0BuW0/video.html
3) MCCQE1: That's a big topic to post about in the comments but most CMGs will use UWorld and @CanadaQbank (they have a CZcams channel that you can check out as well)
4) When you're in residency, make sure you do electives in different settings (academic, community and rural) to help you determine which work settings you would enjoy working in!
Hi Dr. Steph, I have a few billing questions. 1. Special premiums in a PEM (e.g. LTC, home visits etc). Do these patients have to be rostered to you or can they be patients you see outside of your regular FM practice i.e. a side gig? 2. My understanding is that G365 cannot be billed with A003 but K131/132 is okay? 3. I have applied to MOH to join a FHG but it hasn't been approved yet. Do I bill tracking/exclusion codes only after I officially join the FHG (and bill Q200A)? Or do I have to go back and bill the tracking codes afterwards? 4. For patients who had paps within their last 3 years that were done by their previous FMD, can I still bill the tracking code even though it wasn't me who did it? Thank you!
Hi btrcyyl, here are my answers (if others reading this have additional input, feel free to leave a comment):
1) If you're working in a Patient Enrollment Model (PEM), you can bill the special visit premiums regardless of whether the patient is rostered to you or not. For example, even though I do part-time family practice in a FHG, I am called for addiction consults at the hospital. I can bill for the special premiums even though those addiction patients are not rostered to me.
2) A003+G365: Based on the OHIP bulletin, the A003 already includes doing a pap smear so the G365 would be rejected as it would be duplicate. G365 can be billed with K131/132 (I frequently bill this when I do paps at the annual physical).
Source: www.health.gov.on.ca/en/pro/programs/ohip/bulletins/4314/bul4314d.aspx
3) Yes, those Q codes are for enrolled patients only after you've been approved to join the FHG and start enrolling patients to your roster.
4) If the patients are up to date on their pap and was done by another doctor, I would check my Screening Activity Report (SAR) to see if they're marked off as 'no screening required' or 'action overdue'. This is a centralized system, so if they've already done the screen, it would be recorded here. If you don't have an account, I would suggest you get one!
Link: www.cancercareontario.ca/en/guidelines-advice/treatment-modality/primary-care/screening-activity-report
@@BreakingBadDebt Thank you Dr. Steph! I don't remember from where, but I do remember you talked about keeping track of your billings on a separate spreadsheet in addition to the billing software. Would you mind sharing how you do that? Like do you do it per patient encounter (like every healthcard number and every code) or per day? Then do you manually reconcile each item as it comes up on your RA? Thanks so much!
@@btrcyyl7393 Yes, I kept track of OHIP numbers and billed retroactively after I got my billing number. The spreadsheet can be found in the pinned comment of this video: czcams.com/video/CuDsEY2C_OU/video.html
Hi Dr.Steph, thank you for your informative video. Regarding WSIB billing (20:20), if a patient comes in for a workplace injury, but if the workplace is not registered with WSIB or if the patient doesn't know, can we still bill OHIP? or is that uninsured service?
Hi Shawn, it's good that you asked this b/c that's a really common question asked by students in lecture. If the injury occurred at the workplace you can't bill OHIP as it's not covered by OHIP and is considered fraud. If their Employer is not registered with WSIB, you can still submit the Form 8 which means you can still get paid for the form completion, even when "coverage is not indicated." Source: shorturl.at/eAOPQ
If a patient doesn't consent to you reporting to WSIB nor do they want to make a claim with WSIB, you still can't bill OHIP for the service rendered. So the patient would have to pay out of pocket or you would not get paid for the medical services rendered. Source: web.ncf.ca/ex864/schedule/docs/ThirdPartyGuide.pdf
Hope this helps!
I believe you mentioned in previous videos that community EMRs have integrated billing software (plugins?)... Any automatisation assistance for that matter? I mean, does soft helps to generate codes or it is just for submission only?
Yes community EMRs do have billing software integrated in it that is not a plugin. Tbh I haven't encountered very much automatisation for it except for the case of group billing, so if you have a group of patients with all the same code, there's a way for most EMRs to bill as a group. However, this may not be realistic for most doctors if each patient they see are different diagnoses or you spend different amount of time with the patient for time-based codes.
Correction to 12:54 - Health Number Release Service Phone is: 1-888-360-7530
33:06 - E409 is a typo in the SGFP document, should say 1700-2400 for the premium.
For the E409 (scenario #13), shouldn't the premium be from 1700h-2400h? Is that a mistake on the SGFP document?
Yes I think it should be 1700-2400 come to think of it, that must be an error in the SGFP when they printed it as 0500-1200 so the question writer from the OMA put 7am in the question. I think that's why when I saw that, I paused a bit b/c it looked a bit off to me too. It should probably say 7pm did a delivery. E409 isn't just an OB code, it's also used for fam doc procedures after 5pm. Regardless, even with this change I think the answer is still D because you did surgical assist for the C/S at 9pm which is within the premium hours.
- Also just to write it here, there are some SGFP codes that may have been misprints that I've started to notice when working on this lecture. In addition to that one, there's the Influenza Vaccine Enhancement Fee which was printed as Q012A but should be Q102A (pg 6 of SGFP document)
Can you bill A888 for all Walk in clinic visits (scenario #4)? Or only if it's after hours, or weekends?
And if the A888 applies to all walk in clinic visits, how do FHO doctors lose their access bonus at all? i.e. Assuming walk in clinics don't bill the A007 (and use A888 instead), how would a FHO doctor lose their access bonus?
@@JW-ws4op Hi JW, for the A888 it applies for all ER equivalents (Urgent Care, Walk Ins, Extended Hours clinics) in which patients walk in without an appointment. It applies for services provided on Saturday, Sunday or Holiday. Let's say you work on a weekend or evening in a Patient Enrollment Model (PEM) then you get to add on that Q012 bonus for your rostered pt walk ins but not if you're in a FFS walk in. FFS model docs can't bill those bonus Q012/16 codes.
For the reason why billing A888 doesn't cause FHO docs to lose their access bonus, it's because A888 is out of basket. In basket codes like A007 is Expected standard of care a FHO doc is supposed to provide, so when they're not available to provide it and a pt goes to a Walk In instead, and the Walk In Doc bills the A007 - this billing is taken out of the FHO doc's Access Bonus.
Here's a link to the OMA Reference Guide for more info: doctorcare.ca/wp-content/uploads/2017/05/QuickReferenceGuide-A888_EDEquivalent1.pdf?fbclid=IwAR0a1sBalTOYYL33-Zq4KayVc8oWRaZdNEnPvX-GkM7E1vA2nDza0Yj-xDk
@@BreakingBadDebt I see. I think my question was basically: Why would a walk in doctor ever bill A007 instead of A888? And so, it seems that the A888 can only be billed on weekends or holidays, and a walk-in clinic on weekdays would have to bill an A007 instead.
@@JW-ws4opYup, you got it. A Walk In Doc working FFS would bill A888 only if they're working weekends and holidays and all other times they would be billing A007. There's really no financial difference for a FFS doc, it's just out of courtesy for our FHO colleagues.