Maximize Psychiatry billing in Alberta

*update: A big thank you to all who were able to attend! For those of you who weren't lucky enough to attend the live event, we have the replay of the Psychiatry billing webinar available.

How to Fix 16 Common Rejection Codes - Alberta

We see all kinds of reasons that claims get rejected, so we've decided to start shedding some light on the solutions we've found for some of the more common error codes. If your code isn't here, feel free to post to the comments  for any errors that you'd like to see some more information on what exactly Alberta Health Services wants, and how you can fix the problem!

05A  - Invalid Personal Health Number 

     - review for typos, if it looks clean, is it an out of province card and the claim wasn't set to be OOP?

11 - Locum Business Arrangement 

     - When creating an invoice under the advanced tab there is a field for the locum BA. All locum payments will need to be sent with this data. An easy way to send this information is to setup a default invoice template with these details.

Getting started with ClinicAid in Alberta, Ontario, and BC

Need to submit your medical billing claims?

Want to use a simple and intuitive medical billing software to do it?

ClinicAid might just be the solution you're looking for!

But if you're not sure how to get started with ClinicAid, it might seem overwhelming to make the switch or to begin submitting your own claims, even though the process is simple!

Complex care billing in Alberta guide

Are you a physician in Alberta treating patients with complex chronic conditions?

If this is you, you are able to make use of a specific health service code on their claims which will reimburse them for the development of a Comprehensive Annual Care Plan.

The 03.04J service code allows physicians to bill Alberta Health Services for the time and effort spent on creating a complex care plan in cooperation with the patient.

This code may be billed once a year by the physician that is primarily responsible for a patient's care, as long as the patient's chronic conditions meet specific requirements.

Claiming phone calls on Alberta HLINK submissions | ClinicAid blog

Alberta physicians are able to claim phone calls with patients in their medical billing, as long as certain conditions are met.

Phone calls for the following patients may be claimed using the appropriate service codes found in the Schedule of Medical Benefits (SOMB):

Reciprocal billing for Out of Province patients in Alberta | The ClinicAid blog

Reciprocal billing can be one of the more confusing parts of medical billing in Canada. Because each province has its own health care system, agreements have to be made between provinces in order for physicians who see an out-of-province patient to still be paid for the services provided. An Interprovincial Reciprocal Payment Agreement has been established between all of the Canadian provinces and territories (except Quebec) in order to allow for reciprocal billing.

Reciprocal billing works to ensure that all eligible Canadian residents have access to insured health services, regardless of where in Canada they are seeking medical help. Alberta physicians are able to use ClinicAid to create any reciprocal billing claims, as long as some key information is filled out.

If the patient's province and healthcare type is filled out in their demographic record as a non-Alberta province, the bill will be automatically created as an out-of-province bill. The following patient details must also be completed in order for the bill to be processed correctly:

• birth date
• gender
• full address

An out-of-province patient's bill in ClinicAid will automatically:

1. put the out-of-province health card number into the "Registration Number" field in the Advanced tab. It will be removed from the "Health #" field, where it normally would show for an in-province patient.
2. set the "Recovery Code" in the Advanced tab to the appropriate code that matches the out-of-province patient's province/territory.
3. fill out the "Service Recipient" demographic section in the Demographics tab.

Once the bill is sent off to Alberta Health, it will be processed as your other bills are normally. If the bill comes back rejected, you'll be able to view the rejection reason at the top of the invoice and edit the bill as necessary.

New Changes to Alberta Health Schedule of Medical Benefits | ClinicAid Blog

As of April 1st, 2014, recent changes made to the Alberta Health Care Insurance Plan (AHCIP) Schedule of Medical Benefits will come into effect. These changes will affect some codes, facilities, and pricing rates with codes and facilities being removed or added and pricing amounts being changed.

We have updated ClinicAid with the applicable changes to make as many as possible automated within the software. A quick video walk-through of the changes to ClinicAid's medical billing software has also been created and can be found on our YouTube channel, along with other useful tutorials.

Code Changes

Some of the codes that have changed are as follows:
New Service Codes Available as of April 1st, 2014

• 03.05GA 
• 03.44A 
• 07.54B 
• 09.02D 
• 09.02E

These codes will only be found in the search results if the service date for the code is April 1st or later. Trying to bill for these codes for a service date prior to April 1st will result in an error as we've updated ClinicAid to ensure that the codes are billed accurately.

Service Codes No Longer Available as of April 1st, 2014

• 03.05NT
• 03.05ZF
• 03.05BT
• 03.05XT
• 03.05BP
• 03.05BU
• 03.05VQ

These codes will not be available after March 31st, 2014. Much like the new codes, ClinicAid will check the service date you are trying to bill for in order to ensure that you are billing accurately. If you are trying to use on of these codes for a service date after Mach 31st, you will receive an error when saving the bill.

Changed Fee Modifier

The COMX fee modifier for the 03.03D service code (Hospital visits) has been removed and replaced with the COINPT fee modifier. 

Pricing Changes

Some codes have had their rates adjusted. For example, code 03.03D's base value before April 1st was $33.82. As of April 1st, the new base value for this service code will be $40.58. Around 2500 service codes have been updated with new prices.

Facility Changes

A number of facilities have been removed while new ones have been added to the list of valid facility numbers. Again, these will be available depending on the service date when billing within ClinicAid. 

It is important to make note of these changes in order to ensure you are submitting your bills to AHCIP correctly. For more information and the full details behind the changes, as well as an exhaustive list of new codes, prices, and more, please visit the Alberta Medical Association's Billing Corner and view the PDF version of the new Schedule of Medical Benefits that comes into effect on April 1st, 2014.

After-Hours Billing Tip for Alberta's Medical Professionals | ClinicAid Blog

Have you been working after-hours lately? Maximize your billing opportunities by following this useful after-hours billing tip!

Billing for after-hours work for the 2014 statutory holidays

If you're working after hours on stat holidays, there are various modifiers you can use based on the hours you are working. The after-hours time premium (03.01AA) is only applicable to services that are provided at a hospital, auxiliary hospital, active treatment centre, nursing home, or AACC/UCC, not at a physician's private office.

For stat holidays, a 24 hour period is split into 3 increments with different modifiers that are based on the hours worked. If you are working across multiple increments, you are able to use two modifiers for the 03.01AA code to cover the times you are on duty. Please note that there are certain maximums that apply when claiming this health service code.

If you're visiting with a patient before and after midnight, you should claim the after-hours premium on two separate dates of service, one for the date before midnight and one for the date after.

There are also various callback codes that can be used for after-hours work. 

For more information on all of these codes and the appropriate ways to bill them, please see the Alberta Medical Association's after-hours billing page for 2014 stat holidays.

How to Effectively Track Billing with ClinicAid

How much time do you spend in your practice trying to track all of your invoices with the Ministry?

Even the most organized physicians and other medical professionals can find it challenging to monitor the status of billing claims that have been submitted to the government for payment.

Which ones have been paid? Was that one returned? How many are still being processed for payment?

It can be a tedious and annoying time drain to keep track of all the various bills that are out there once they've been submitted. But no physician wants to lose a payment because of an invoice that fell through the cracks due to a diagnostic error, failure to follow up if some action is required, or some other discrepancy.

ClinicAid’s "Requires Action" Tab is a built-in reminder feature that can remind physicians about bills and keep them updated on the status of each and every bill.

If you are already using ClinicAid’s cloud-based billing service you may be unaware of this feature. And if you are not using ClinicAid  you might consider checking it out as an option for quick and easy web-based billing in BC, Alberta and Ontario. 

ClinicAid is the only billing program that is integrated with OSCAR EMR software for medical billing in BC, Alberta and Ontario to take over the cumbersome native billing process.

The "Requires Action" Tab works through a reporting system that is generated by return remittance from the Ministry.

When the user clicks on the "Requires Action" Tab in their ClinicAid system, data pops up to indicate which, if any bills haven’t been paid, which bills have been kicked back for some reason, and which bills require some kind of action to be processed.

It’s a handy feature that keeps billing issues that could easily be forgotten top of mind for a busy practice – that’s because unresolved billing issues will continue to appear in the "Requires Action" Tab until appropriate action is taken for each bill.

Keeping this data constant in view has shown to save practices thousands of dollars in returned invoices that haven't slipped through the cracks.

The "Requires Action" Tab is just one more aspect of ClinicAid’s cloud-based billing system that allows physicians to focus on patient issues rather than worrying about invoices and whether they will be paid.

It’s another effective tool that helps physicians focus more attention on their patients instead of the administrative minutiae of their practice.