This article was originally published by Dr. Bill and has been modified for a different audience.
Navigating the complexities of medical billing in Canada can feel daunting for specialist physicians—especially if you’re new to billing. Rest assured—the rules, codes and processes might appear overwhelming initially, but with the right knowledge and tools in place, you can breeze through billing and feel more confident you’re claiming fully for your work.
Here, we’ve assembled 8 of our top medical billing tips and best practices for new and seasoned specialist physicians alike:
1. Create a Billing Cheat Sheet
Reduce the need to constantly navigate your province’s master schedule of codes by creating a one or two-page cheat sheet for frequently used codes in your practice. Helpful information to include on a cheat sheet includes:
- Billing Codes
- Diagnostic Codes
- Premiums
- Restrictions
- Indirect codes (for consultations, emails, etc.)
Tip: Try searching for the codes you need by keyword in your province or territory’s online database.
2. Submit Claims on Time
Billing regularly (daily or weekly) is recommended to ensure you don’t miss a payment cycle and maintain regular cash flow. Ministry claim submission cut-off dates vary widely. For instance, physicians in Alberta have weekly Ministry cut-off and payment dates, while physicians in Ontario have monthly cut-offs and payments.
Tip: Check to see if your province or territory offers email cut-off alerts, they can help you avoid missing a cut-off date.
Beyond maintaining cash flow, claims that are submitted too late may need to go through a lengthy review process or may not be eligible for payment at all (depending on your province). Most provinces have a 3-month window from the date of service until claims are considered “stale dated” or “over-age,” though some provinces, such as Saskatchewan, offer a 6-month window.
3. Bill Accurately
Billing accurately is important for ensuring you are paid fully for the work you do. It is also critically important for your billing to accurately match your patient records, especially in the case of an audit.
4. Bill for Telephone Consultations
Many doctors regularly engage in phone and e-consultations, yet neglect to bill for them, which adds up to a lot of unpaid work. Generally, both the referring physician (the doctor who initiates a call) and the consultant physician (the doctor who receives the call) can bill for these consults.
Depending on your province, you may also be eligible to bill for providing advice to other registered healthcare workers such as paramedics, assisted living staff, long term care workers, public health nurses and more (when calls are initiated by the other healthcare worker). Refer to the guidelines in your province to confirm these rules and then add consult codes to your cheat sheet.
5. Maximize Government Incentives
All provinces and territories can offer incentives of some kind, for example, The Business Cost Premium in B.C. can help eligible physicians cover rising overhead costs and the Rural/remote premiums in Alberta can compensate physicians for practicing in underserved areas. While these are just a couple of examples, you can contact your provincial Ministry of Health to ensure you are enrolled in all applicable programs and understand how and when to bill for them.
6. Add Applicable Premiums
When creating your billing cheat sheet, don’t forget to list frequently-used premium codes as well. Depending on your province and specialty, premiums can increase the value of a service provided based on elements such as service/patient complexity, physician role, time of day and length of time spent with a patient.
Tip: Premiums are an important part of the claims process and can easily be forgotten. Consider using a billing system that displays automatic alerts when premiums may apply to your claims. It can help to ensure you are paid accurately for your work.
7. Minimize Rejections
The process of investigating, correcting and resubmitting rejected, refused and reduced claims can become arduous for physicians. As a result, some physicians simply end up letting some or all rejections go, which can add up to a lot of lost revenue over time.
Keep these top 5 rejection-reducing tips in mind:
- Add a referring physician when applicable (it’s the most common reason for refusals!)
- Don’t forget to add the hospital admission date when billing for inpatients
- Remember to include your service location or facility code if applicable
- Avoid fee code conflicts (e.g. codes that can’t be billed together or billed under your specialty)
- Confirm coverage and patient health card details at the start of each visit
8. Choose the Right Billing Solution
The right medical billing solution for you will depend on your specialty, work setting, billing complexity and personal preference. Options range from using your EMR, outsourcing billing entirely to a billing agent or using medical billing software.
Implementing these tips can not only contribute to more streamlined billing, but more accurate billing as well.
This article is intended as general information only and is not to be relied upon as constituting legal, financial or other professional advice. A professional advisor should be consulted regarding your specific situation. Information presented is believed to be factual and up-to-date but we do not guarantee its accuracy and it should not be regarded as a complete analysis of the subjects discussed. All expressions of opinion reflect the judgment of the authors as of the date of publication and are subject to change. No endorsement of any third parties or their advice, opinions, information, products or services is expressly given or implied by Royal Bank of Canada or any of its affiliates.
