Alberta Billing Best Practices

Whether you’re a recent grad, new to practicing in Alberta or trying to grasp the whole “fee-for-service” model, this guide is intended to help you create, or improve, your workflow efficiency so that you’re not losing time trying to figure it all out. Billing for reimbursement in Alberta can be tedious and time-consuming, but it doesn’t have to be!

Follow these easy to implement strategies and resources to improve productivity, maximize earnings and ultimately, save time.

1. Ways to Maximize Billings

Make sure you utilize premiums, modifiers and other incentives – our billing agents always see doctors missing out on these easy extras.

Telephone Calls

We’ve noticed that most doctors aren’t billing for telephone follow ups or consultations, even though they can add up quickly and can be quite lucrative. For example, fee code 03.05JR can be billed for any phone call made to your patient to discuss patient management/diagnostic test results and has a value of $20/per 15 minutes. It can also be claimed in addition to others visits or other services that you’ve provided that patient with on the same day.

In general, most telephone and consultation codes are underused. Click here to find out which codes you can use today.

Modifiers

AHCIP Modifiers are used to increase a claim amount for a specific reason. For example, the BMI modifier increases the claim amount based on the fact that your patient’s BMI (Body Mass Index) score is greater than 40. Another great modifier to use is the complex modifier (CMGP) which compensates you for a number of services that are not “face-to-face,” for example, charting, or anything else that you do in relation to patient care.

You can search and learn more about all AHCIP modifiers using the searchable database here.

The After-Hour Premium – 03.01AA

This is a great code to use if you’re working late in active treatment hospitals, nursing homes or auxiliary hospitals. Alberta Health defines “After hours” as 5 p.m. to 7 a.m. on weekdays, and any time on weekends, statutory or designated holidays. This code can be claimed for charting, reviewing (but not waiting for) lab or DI results, consulting with other health providers on the service about the patients care, writing a referral/consultant letter and any other activities that are included in managing the patients’ care.

It’s claimed in 15-minute units and must include a modifier that indicates the time of day and how long it took. Modifiers range from $22.79/$45.55 per unit.

Rural Incentives

It’s a good idea to double check to see if you’re working in a qualified rural area under the RRNP (Rural Remote Northern Program). The RRNP helps compensate physicians who practice in under-serviced areas throughout Alberta.

To find out if the community you’ll be working in is eligible click here.

If you do qualify and are using Dr.Bill, this rural location can be added to your account settings in order to make sure that any rural incentives will automatically apply to all your claims.

2. Things to Avoid

Submission Errors

One of the biggest mistakes when submitting claims for reimbursement is getting a submission error. What’s a submission error? Submission errors are claims that have not passed the pre-edit approval process by AHCIP.

Unquestionably, these will happen, especially if you’re billing in high volumes, because let’s face it; everyone makes mistakes. Although getting a submission error is not the end of the world, it will delay your pay. Here are some common scenarios to watch out for:

• Location of fee code doesn’t match. I.e., radiologic fee code performed in ER

• There’s a fee code conflict – so assessment is required

• Invalid use of Premiums

• No Referring Physician

• Patient doesn’t have insurance

Extra Reminder: In our experience, most submission errors are a direct result of either not adding a referring physician OR not double checking that your patient has insurance. So, make sure you always check these two things before submitting a claim.

Missing Time

You know what they say, time is money, and that is no exception when billing fee-for-service. Almost everything you do as a doctor is time-based, from patient visits to procedures; this is why remembering the start and end times is so important and this is also why not recording your time properly results in a huge amount of lost revenue. Our best suggestion? Make sure you bill daily, or even better directly after each procedure/visit.

Research by the Canadian Medical Association shows that the average physician fails to bill for at least 5% of the insured services they provide. This translates to almost $24,000 per year! This will not only help you get into the habit of billing but it will make sure you’re getting paid properly for the work you do because everything will still be fresh in your mind.

For a complete guide on how to submit claims for refurbishment in Alberta check out our Alberta Health Billing Guide.

3. The Best AHCIP Resources for Quick Searches

Learning how to bill properly can be painful and extremely frustrating, but these are unfortunately some of the realities of medical billing. However, if order to ease your headache we’ve created some quick links to help you tackle your billing and find the codes you need in a timelier manner.

Reduce Your Workload and Bill Better Today:

• Alberta Health Billing Codes Searchable Database

• Getting Submission Errors/Rejections? Figure out what the codes mean here: Alberta Health Billing Explanatory Codes

• Alberta Health Service Code Fee Modifier Definitions

4. Advantages of Mobile Billing

Billing can be painful. It’s often overwhelming and exhausting trying to figure out which code goes with what and when a modifier is allowed or not. The reality is that, often, piles of unending and confusing paperwork is required to be carefully filled out, all just so you can get paid! Then, there’s the surprise of getting a submission error or rejection, which not only delays your pay but is often confusing since you may not know what went wrong.

There is a better way though and it does not have to be this tedious. Mobile billing apps let you cut down on paperwork and bill in minutes, not hours! Even the Canadian Medical Association (CMA) recommends using mobile apps, and estimates that the average physician fails to claim at least 5 percent of services. This means, if you’re billing $300,000 each year, you’d be losing out on at least $15,000!

Here are just some of the benefits of billing from your smartphone:

• Saves you time

• You can Earn More

• Reminders and Billing Tips

• Manage Claims Securely (Mobile billing software uses Bank-level encryption so your patient’s information is always safe).

For example, here are the results from when we surveyed our users and asked them “Has Dr.Bill helped you earn more money?”

5. Benefits of Using Dr.Bill

Although we’re not the only billing app out there, we are powered by real humans that can help you say goodbye to billing headaches for good. With us you can snap pictures of your patient data and log claims in under 30 seconds. No more day sheets!

Best of all, our billing agents are real humans and AHCIP experts who know all the ins and out of the billing world. Not only will they manage your rejections but you can ask them for help anytime you need to double check something.

In general, being a young software company, we’re able to make unique changes to our system that really meet your needs. We routinely ask for feedback so that our software is up to date and innovating. Working with our users has led us to create amazing tools such as easily duplicating Past Claims with the same billing & diagnostic codes, choose among multiple business arrangements for each claim, and having the option to star your most commonly used billing codes.

Start your free trial today