How to maximize your OHIP billing payouts

How to Maximize your OHIP Billing Payouts

1. Know your codes. If you are submitting claims yourself, you would be wise to spend some time learning the OHIP billing codes applicable to your specialty.  You are likely already familiar with consult, assessment, counselling, individual care, follow-up and critical care codes; but do you know which of these codes can and can’t be billed together? Many people will try to submit all of the applicable codes and hope for the best. You should know that in this scenario, OHIP automatically pays out the lowest codes applicable; whereas a little knowledge about which codes go together can often net you a higher payoff. 
   
2. Remember to bill premiums. Time of day visit, diagnostic procedure and critical care premiums as well as travel premiums for being called-in to hospital can add significantly to your paycheque. 
   
3. Know how to bill diagnostic procedures. You likely know that you can bill professional components to the diagnostic procedures you are ordering, but in some cases you can also bill technical component fees. Find out if your training qualifies you to claim these fees.
   
4. Submit all your non-OHIP claims. Your medical billing software will allow you to easily submit claims for OHIP and RMB (out of province, except for Quebec). Do you ever see patients with private insurance plans – travel insurance, international student insurance, or Quebec residents? If you are in a major urban centre you will likely see refugee patients registered with Interim Federal Health as well. You are able to claim fees for services rendered to all of these patients, but you need to know which forms to fill out and where to send them. And don’t forget, like OHIP, many of these agencies will only accept claims within a specific time period (typically up to 6 months following service date).
   
5. Get advice from people with billing experience in your specialty. Have a terrific new administrative assistant? That’s wonderful, they will add to your practice in many ways. But if they don’t have billing experience specific to your specialty, you may still be leaving money on the table. Ask around to make sure this doesn’t happen while your new employee gets up to speed.
   
6. Strongly consider hiring a billing agent. An experienced billing agent has likely worked in your area, and also has a network of other billers to advise them. An agent can cut down on the need for you to memorize which visit codes pay out the best at which time of day; an agent will choose the applicable ones that pays you the most. They will remember to add premium codes when you don’t. They are also familiar with diagnostic codes, and are experts at filling out forms that result in payments for you. Billing agents will literally pay for themselves.