Members vs Non-Members

Most people stumble across our blog when they are searching the internet for clarification regarding an OHIP medical billing code (or medical billing precedural). OMBIS Inc., was created out of a need for a platform that would address gaps in knowledge, and provide a forum for sharing questions and knowledge. OMBIS Inc., provides information on billing codes and procedures here on Blogger and we also do that in a much more comprehensive way for our members at www.ombis.ca.

What's the difference between members and non-members?

Our members (www.ombis.ca) send us questions and we will search for answers then email them back with a response. Non-members can also send us questions or topics that they would like to see a posting on as suggestions; however, our members get our special attention when it comes to finding answers to specific questions and/or concerns.

Our members also enjoy access to resources (preventative health care forms, practice management forms, etc.) and a search engine with thousands of OHIP codes that is put together in a way that takes the guess work out of billing. Our search engine took months to compile and will tell you what codes are allowable (not-allowable), details limits and specific considerations as well as links you to relevant OHIP memorandums and additional third party resources.

Member's also enjoy a 50% discount on all customized resource packages like the customized insurance form package that we were telling you about here.

More Money, Less Hassle....What are you waiting for?

In the past we have discussed the headaches associated with handing Attending Physician Requests and Disease Specific Questionnaires, to read the post click here.  Due to all of the questions we received from members (and blog followers!) about how to make sure they are being compensated while making sure they are still following the OMA's recommended guidelines we created a solution.  Our solution is a customized insurance form package.  This package includes a customized invoice and form that allows your staff to simply figure out how to invoice the insurance company while increasing your income and ensuring OMA rate compliance.  This package also comes with a letter that will provide you with step-by-step instructions as to how to implement this new system. 

No more fighting for payment after you have completed your APS request, no more feeling like you are underpaid and no more frustration with all of the "rush" requests you receive.  The customized package is $30.00 plus HST. 

We offer group discounts for multiple physicians (each physician will receive a separate customized form).  OMBIS member's enjoy a discounted rate of 50% off of all additional resource packages, which means our member price for this package is $15.00 plus HST.

New members who join during the remainder of January will receive a customized insurance form package at no additional charge!

Email us at administration@ombis.ca and we'll get you maximizing your income right away.

To Google or Not to Google? Self-Diagnosis Online

A new article out, published this past week, indicates that 1 in 3 (U.S. study) adults have searched online for a medical diagnosis.  If you haven't seen the article you can follow this link to the Huffington Post and read it there.

There is no denying that the internet has changed medicine in more ways than one and that one of the biggest may arguably be self-diagnosis based on internet search results.  Everyone has had more than one frantic patient convinced that the rash and fever presenting simultaneously is a sure sign of impending death (as per internet searches), however, there are also times that patient's doing their own research can be beneficial in helping them to understand the ins and outs of a disease/condition that they may be facing.  It's hard not to be offended when your treatment plan is being compared against something that was searched online.  Sometimes patient's assume that you didn't recommend something because you weren't aware of it when the reality is you may have ruled it out as not being suitable.  The physician and patient interactions have changed significantly since the introduction of technology and as our culture becomes more integrated with new technology the traditional ways of how medicine works will continue to change and be challenged.

The problem is figuring out how to embrace the benefits and place boundaries around the potential issues when trying to integrate this into your practice.  There is no doubt that even physicians are more reliant on online referencing of conditions and medications, gone are the days of running to the bookshelf and dusting off the textbooks.

Here are some of our recommendations to find a healthy balance in your practice.

1.  Embrace the idea of patients willing to take some ownership over their health outcomes, as long as it's health and based in reality.  Patients increasing their knowledge and understanding of their condition is absolutely beneficial - as long as they are finding/receiving the right information. 

2.  Find some online medical sites that you feel can be trusted and help redirect patients to trusted sources, rather than last week's highlighted article on an obscure flawed study.

3.  Print out some information pages on commonly discussed conditions (hypertension, diabetes, etc.) that you can give a patient to take home and read.  This way you know exactly what they are relying on and they get to gain insight while you benefit from knowing that they are being given factual information.

4.  Keep a list of books to recommend to people who are facing chronic conditions or difficult diagnoses such as cancer.  This will give them someplace to turn to find trusted resources.

This is the information age, today more and more people are turning to the internet (most easily accessible resource) to gain information and knowledge.  The internet doesn't have to be the elephant in the room, maybe you can harness it to become beneficial for both you and your patients. 

Changes Coming to Pap Screening Guidelines

The Canadian Task Force on Preventative Care has changed their reccomendations for Pap screening.  Click here to read the full article that was published online by the Canadian Medical Association Journal.

Currently the guidelines suggest that Pap screening should begin in sexually active woman at age 21, however, the panel is now recommending that Pap screening should begin at age 25.  This new reccomendation seems a bit counter-intuitive initially when you are looking at it from a standpoint of HPV screening, however, the article details that this new reccomendation is to do with potential harm done by the screening.

Basically, the potential harm identified is anxiety, false positives then resulting in unecessary further investigations and/or treatments.  Anxiety aside, further investigations and treatments can involve biopsies or partial cervix removal which in turn can cause scarring leading to miscarriage and/or premature labour.

The guidelines recommend continuing on a screening interval of every three years and to be discontinued at age 70 (or older) when there has been a history of three successive negative Pap smears done. 

Each individual patient should be taken into consideration for issues such as immune deficiency which would require screening more frequently, or complete hysterectomy (non-cancerous) which would no longer require Pap smear screening.

 

Physicians: Start Gaining Income You Are Already Doing the Work For!

So earlier in the week we discussed some of the perils of dealing with requests for record releases http://ontariomedicalbillingblog.blogspot.ca/2012/08/have-you-inadvertently-opened-up-your.html , today we're going to take a look at how you can increase your income for dealing with those cumbersome record releases and Attending Physician Statement requests. Every clinic who has dealt with a request from an insurance company has received that faxed request that asks for certain information and tells you how much they are "approved" to pay for the information requested. So the logical process is to complete the work and invoice for the amount approved, right?

NO! Stop! Ask yourself if the "approved" amount actually covers your time and expenses? You are under absolutely no obligation to be bullied by insurance companies or to let them dictate what YOUR invoice will be. Insurance companies save a TON of money by noting the "approved" amount and medical clinics falling in line only billing the "approved" number. They want to get those records/reports as soon as possible so you don't need to worry that you will delay the process; most of what is said on that initial form is purely tactics to get you to do what they want. As soon as that faxed request comes in you should promptly ignore the "approved" amount and calculate exactly what your invoice will be, of course ensuring compliance with the OMA suggested rates. Next step should be to send your own fax back to the company stating exactly what your fee will be. The form you send should have a section where you receive a signed and dated agreement from the insurance company BEFORE you even begin to complete their request. Insurance companies have been known to go back on what they say unless there is written proof, this form is your clarification, time saver and written proof all in one.

Most physicians groan whenever they receive one of these insurance company requests because they feel as though they are severely underpaid; the reality is they are only underpaid because they are being manipulated. Now that you know the tactics, you can take a deep breath and increase your income based on work you are already completing. Just make sure that the final invoice is in line with the recommended OMA rates.

In our next blog we will touch on appropriate wait times and how long it should take for your information release turnaround. We are currently putting the finishing touches on a Record Release Package that will include a form (as noted above) to send back to the insurance company for clarification and written proof. The package will also include an information pamphlet for front desk staff and other resources to increase your income and make your clinic run smoothly and legally compliant. The package will be $30.00, if you are interested shoot us an email at administration@ombis.ca .

Have You Inadvertently Opened Up Your Practice For a Lawsuit?

The hassles of record releases are one that every office deals with on a frequent basis, but is your office dealing with them properly? Don't assume the answer to that question is Yes; it's far more likely than not you need to review your process in handling record releases.
Let's look at some of the issues:

1. Not receiving a signed authorization for release of records from patient. This is the most basic issue and because it's so basic sometimes it's overlooked. No patient history should be released or discussed verbally with a third party unless there is an authorization for record release that is signed and dated by the patient, ever!
   
    
2. Release of records request too vague? Insurance companies and third parties are not permitted to go on fishing expeditions for information which means they must have specifics noted in the request. For example: "blood-work from January 1, 2005 to date" and "any and all investigations, records, and/or blood-work pertaining to diabetes" are perfectly reasonable requests because of their specificity. Now, if you receive a vague request and you basically send the entire chart (unbeknownst to the patient) which is outside of the scope of the patient's authorization, you could be jumping into some hot water. Should something within the chart (that was sent) include something that the patient wasn't aware would be sent and ends up in a denial of an insurance policy or claim, you may successfully be sued by your patient.
   
    
3. It is always your duty to protect your patient. You always have the right to request clarification on any request you receive and refuse to release the records unless they provide specific requests. If there is any doubt (and the request is vague) you are likely well served by contacting the patient and ensuring they are aware of what is being requested (you will be shocked to find out how often they will say they had no idea or they believed it was for certain specific records, not the entire chart). Two minutes in a phone call can save you a lot of hassle (or even a potential lawsuit) down the road.

This information is great for physicians to know but ALL front office staff and office management must be made aware as well, they are your representatives in how they handle your records but you will be held responsible for all of the liability should something be handled improperly. Remember that "I didn't know" won't get you out of hot water, it's your responsibility to know and make sure that your staff know, period.
We are just putting finishing touches on some resources for your front desk staff, including a resource package created specifically on handling record release requests and a form to make sure you are being paid what you should be for the time and resources required to complete the release (more on money and releases in our next blog!), this package will inform your clinic staff and increase your earnings at a price of $30. If you are interested in this record release package send us an email at administration@ombis.ca .

Ontario Cancels Cuts to Diagnositic Cuts....Pending Review

Usually we don't post news on this forum, we post all relevant new-related posts on our facebook page at http://www.facebook.com/pages/Ontario-Medical-Billing-Information-Support/116380025108396  but we felt that you should be aware of this! 

Here is an article from The Globe And Mail announcing that Ontario has cancelled the cuts to diagnostic fees, for now anyway.  They will still be reviewed and a decision will be made following the outcome of the review.

Read more:  http://www.theglobeandmail.com/news/national/ontario-cancels-cuts-to-doctors-diagnostic-fees/article4380950/

If you would like to receive updates, such as the article above, then hop over to Facebook and like our page.  Our article postings will show up on your news feed when you log in.  We only post news that we feel you should be aware of.   http://www.facebook.com/pages/Ontario-Medical-Billing-Information-Support/116380025108396