ble for billing, but you will have the administrative support of your staff, who can submit billings on your behalf and reconcile them later in the process. Your staff will require sufficient and ongoing training and support to help you to maximize your billing potential. Keep in mind that your own financial future is on the line, so ensure your staff have the tools and training they need to help make it a success. Be aware that some hospitals or clinics will try to include a billing clause in your lease or employment contract, stating that your billing must be done by their staff. Don’t limit your options by agreeing to a clause like this—it’s your own financial security at stake.
Billing agencies
A billing agency is to your billing what a tax accountant is to your tax return: an expert you hire to do a job to the best of their ability and knowledge. This agent has a vested interest in col-
lecting all billings submitted under your number, and will know the latest changes to the fee schedule. The cost of the service is minimal and tax- deductible. Every medical association should have a list of billing agents used by their members. Some agencies offer a basic service, while others will look after all your billing, from data entry to rebilling and reconciliation, ensuring the accuracy of your coding and offer- ing advice on how to maximize your revenue. In our view, the best billing agencies are those with the most expe- rienced managers. Despite what some salespeople may have you believe, it is impossible to acquire overnight all the expertise needed to effectively provide billing services for several physicians at a time. Again, your financial future is at stake, so your interests must come first. As such, don’t feel guilty about re- fusing to hand your billing over to your colleague’s wife or the nurse in your department. After all, a good billing
agency is a full-time en- deavour. Make sure your agency has the staff required take on your billing if the man- ager falls ill or goes on vacation. In the end, regardless of who enters your billing codes, you must take accounta- bility and ownership of how your billing is managed. Stay up-to-date on billing fees, read bulletins, attend seminars and take advantage of the learning opportunities presented to you. How they work
Billing agencies generally charge be- tween 1.5 and 4 per cent of your gross fees. Some agencies charge a set amount per medical procedure, others have fixed hourly rates. Both are ac- ceptable options. Billing agencies can- not deduct their fees directly from your revenues; rather, your agency will send you a monthly or quarterly invoice that you must pay as per the agreed-upon terms and conditions. Your billing staff or agents will close the billing loop with the following process. They will require demographic information about the pa- tient, their provincial health card num- ber, the service or procedural codes, the diagnosis and the referring physician. In some cases you may be required to also provide details of the institution, admission date or time a particular service was performed. Your billing agent will tell you the requirements for your field of practice. The information is faxed to the agency (or picked up) based on a predetermined schedule. These duly completed requests then are forwarded for payment to the MoH, which will pay you in the weeks to fol- low. The agency receives a remittance statement in your name and must rec- oncile the amounts billed with the amounts received. In the case of an error, certain procedures must be re- billed. The reconciliation and rebilling stages are those most often botched by physicians, administrative staff and agencies, though it is easy enough to recover the amounts in question. The lesson here? Make sure your agency doesn’t just “talk the talk,” but “walks the walk” too. ⌧
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One of the best bits of advice for your smooth transition to practice is to learn as much about billing before you finish residency. Seminars based on the CMA practice management curriculum modules are offered annually, and case-based billing workshops are offered espe- cially to family medicine practitioners in most provinces. Also, get cozy with your provincial billing guide: browse, read, ask questions and simply get to know your billing codes. Since all billing guides are available online (except in Nova Scotia), there is no excuse not to do it!
Alberta http://www.health.alberta.ca/professionals/somb.html British Columbia http://www.health.gov.bc.ca/msp/infoprac/physbilling/payschedule/index.html Manitoba http://www.gov.mb.ca/health/manual/index.html New Brunswick http://www.gnb.ca/0394/pdf-en/PhysiciansManual-e.pdf
Newfoundland and Labrador
http://www.health.gov.nl.ca/mcp/html/download.htm
Northwest Territories
http://www.hlthss.gov.nt.ca/english/services/health_care_plan/pdf/insured_services_tariff.pdf
Nova Scotia
Not available online. To request a copy of the Medical Services Insurance (MSI) Physician’s Manual, contact MSI at (902) 468-9700.
Nunavut
See Northwest Territories fee schedule.
Ontario
www.health.gov.on.ca/english/providers/program/ohip/sob/physserv/physserv_mn.html
Prince Edward Island
http://www.gov.pe.ca/hss/medical/index.php3
Quebec - General Practitioners (in French only)
Manual: http://www.ramq.gouv.qc.ca/fr/professionnels/manuels/100/000_complet_acte_omni.pdf Brochure: http://www.ramq.gouv.qc.ca/fr/professionnels/manuels/104/000_complet_entente_omni.pdf
Quebec - Medical Specialists (in French only)
Manual: http://www.ramq.gouv.qc.ca/fr/professionnels/manuels/150/000_complet_acte_spec.pdf Brochure: http://www.ramq.gouv.qc.ca/fr/professionnels/manuels/154/000_complet_acc_cadre_spec.pdf Saskatchewan http://www.health.gov.sk.ca/physician-information Yukon Territory http://www.hss.gov.yk.ca/downloads/319_physicianfeeguide_200809.pdf
New in Practice 2009: What medical residents need to know before entering practice