Important Agreement Changes for FHG & CCM

There have been some unilateral agreement changes made that affect both Family Health Groups and Comprehensive Care Models.  If you are in either of these groups it's important that you read each of the bulletins regarding the changes.  You have 30 days from the date of the imposed changes to terminate your affiliation with the respective group, or, it will be assumed that you have actively agreed to these changes.  According to the attached bulletins they affect terms of the agreement with respect to leaving the affected groups.

Here is the link to the bulletin for the Family Health Group (FHG) changes. 

Here is the link to the bulletin for the Comprehensive Care Model changes.

While they are not major changes it would still be adviseable to be aware of them if you are in either of these groups.

Back to Basics & Dreaded MOH Error Reports

We all know that medical billing is complicated and extremely detail oriented.   OHIP billing is so detail oriented that it's downright overwhelming.  We have yet to come across the path of anyone that can confidently say "I have an amazing handle on it and I know that I am billing everything appropriately and not missing one code, ever"....not a doctor, not a billing agent and not an OHIP billing company.  How do you feel you are doing in making sure you are claiming all of the income (either for yourself or your employer) that has already been earned? 

In order to get closer to our ultimate goals we have to be purposeful in taking steps that get us there, the same is true when you are dealing with OHIP billing. 

Aside from joining our OMBIS members (enjoying our membership resources, OHIP code database and personal support when they need it) you have to employ a strategy.  The best places to start looking for lost income is often the most basic places, like the dreaded RA & Errors Reports.  Our employees have sat through OMA Medical Billing Conferences and listened to office staff explain that they have literally never actually done any error reconciliations ever because they don't know how to read the rejection report and/or the RAs. 

Is this true for you?  Do you reconcile the easy errors and then say you'll go back but never actually get around to it?  Are there errors that you don't quite understand so you just leave them?  Be honest in your evaluation and ask yourself how often this happens (even if it's just those darn errors that seem to keep coming back). 

Maybe after reading this you are feeling like you are in a good position because you think that around 95% of the time you get those errors reconciled....hang on a second!  Are you willing to forget about 5% of your income (or your employer's)? 

Figure out how to make that attainment rate 99%, or better yet 100% when it comes to errors and reconciliation.   Maybe it means that you need to re-evaluate office procedures in order to make sure you manage to get valid health card numbers for those EH2 errors, or maybe you need to make sure they are right to begin with so that you don't have to deal with them afterwards.  There are many other ways to increase your income and billing efficiency, but errors and reconciliation is definitely a place that shouldn't go unchecked.

If you are a physician and now you are stressed out worrying if your office staff is handling these errors in an appropriate way, why don't you sit down with them and ask them honestly how things are going.  You may think everything is going well and could be surprised at what the reality is.  If your staff is having a hard time, don't blame them, OHIP medical billing is pretty complicated.  Work together to make your systems better, it's better for you and your staff.

If you are a member and you are concerned that this could be an issue in your office (either directly or with office staff), send us an email and we'll work together to ensure you have an efficient system in place.  administration@ombis.ca