8 Medical Billing Tips to help you fully claim for your work

This article was originally published by Dr. Bill and has been modified for a different audience.

Medical billing likely wasn’t something you covered in training – and with all the rules, codes and processes, it can feel overwhelming at times, especially if you’re new to it. But with the right knowledge and tools, billing doesn’t have to be a headache.

Here are 8 tips and best practices to help make billing easier and ensure you’re claiming fully for your work:

1. Create a Billing Cheat Sheet

Instead of constantly digging through your province’s master schedule of codes, try putting together a simple one- or two-page cheat sheet with the codes you use most often. It’s a quick way to save time and avoid frustration during busy days. You might want to include things like:

• 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. Each province has its own billing codes, which are typically available through their provincial Ministry of Health website.

2. Submit Claims on Time

It’s a good idea to bill regularly – either daily or weekly – to help keep your cash flow steady and make sure you don’t miss a payment cycle. Submission deadlines can vary quite a bit depending on where you practise. For example, physicians in Alberta have weekly cut-off and payment dates, while in Ontario, the schedule is monthly.

Submitting claims on time can help you avoid delays or missed payments. If a claim is submitted too late, it might need to go through a longer review process or, in some cases, may not be eligible for payment at all, depending on your province. Most provinces give you a 3-month window from the date of service before a claim is considered “stale-dated” or “over-age”, though some, like Saskatchewan, allow up to 6 months.

Tip: Check to see if your province or territory offers email cut-off alerts, they can help you avoid missing a cut-off date.

3. Bill Accurately

Accurate billing helps make sure you’re fully paid for the work you do, but also that your billing matches your patient records. This becomes especially important if your claims are ever audited.

4. Bill for Telephone Consultations

Many doctors do phone and e-consultations as part of their routine but often forget to bill for them. Over time, that can add up to a surprising amount of unpaid work. In most cases, both the referring doctor (the one who initiates the consult) and the consulting doctor (the one who takes the call) can submit a claim.

Depending on your province, you might also be able to bill for providing advice to other registered healthcare professionals – like paramedics, assisted-living staff, long-term care workers, public health nurses, and others – when they reach out to you. Be sure to check your provincial guidelines to confirm what’s eligible, and if it applies, add the relevant consult codes to your cheat sheet for easy reference.

5. Maximize Government Incentives

Most provinces and territories offer some kind of incentive program. For example, the Business Cost Premium in B.C. can help eligible physicians cover rising overhead costs, while the Rural Remote Northern Program in Alberta compensates physicians who practise in underserved areas. These are just a couple of examples – there may be others you qualify for. Be sure to check with your provincial Ministry of Health to make sure you’re enrolled in all the programs you’re eligible for, and that you know how and when to bill for them.

6. Add Applicable Premiums

When putting together your billing cheat sheet, be sure to include the premium codes you use often. Depending on your province and specialty, these premiums can boost the value of a service based on factors like patient or service complexity, your role, the time of day, or how long you spend with the patient.

Tip: Premiums are an important part of the claims process, but they can easily be overlooked. Consider using a billing system that displays automatic alerts when premiums may apply to your claims. It can help make sure you’re getting paid accurately for your work.

7. Minimize Rejections

Dealing with rejected, refused or reduced claims can be a real hassle for physicians. Tracking down the issue, correcting and resubmitting claims take time, so it’s no surprise that some physicians simply let the rejections go. But over time, that can add up to a significant loss in revenue.

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
• Include your service location or facility code, if applicable
• Avoid fee code conflicts (for example, 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 best medical billing solution for you will depend on your specialty, work setting, billing complexity and personal preferences. You have a few options: you can use your EMR, outsource billing to a billing agent or opt for dedicated medical billing software to make managing your claims much more efficient.

If you’re in the market for billing software, look for time-saving features like:

1. Smart billing automation – Lets you quickly add fee codes and diagnoses with just a few taps, helping you avoid common mistakes
2. Ability to add multiple patients to a single claim – Saves you the time and hassle of submitting claims individually
3. Collaboration tools – Allows you to work with other doctors in your office to streamline billing
4. Transparent reporting – So you can keep an eye all your active claims, which is especially helpful for tracking fee-for-service billing
5. Rejection management – Support from billing advisors who can help you understand your claim rejection and guide you through the best way to resubmit

With the right tools and best practices, you can streamline the billing process and make sure you’re claiming fully for your work – with fewer headaches and a healthier bottom line.

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