Family Medicine Billing Made Simple: Guide for FHO Doctors in Ontario (Pt 1)

[@aparna852002]

Woah !! As if the years of prep pre med, med school and residency werent enough ! A big bow to all our doctors in family practice !!

[@BreakingBadDebt]

𝗧𝗼𝗽𝗶𝗰𝘀 𝗖𝗼𝘃𝗲𝗿𝗲𝗱: 0:00 - Intro 2:58 - Resources 6:38 - Capitation & How much you make in a FHO model 14:14 - Shadow Billing 15:50 - Pros & Cons of working in a FHO model 19:01 - FHO Billing Codes 33:13 - Specific Premiums (Home Visit, Long-Term Care, L&D, Palliative) ** 2023 UPDATE - NEW SGFP BILLING GUIDE: sgfp.ca/rails/active_storage/blobs/proxy/eyJfcmFpbHMiOnsibWVzc2FnZSI6IkJBaHBBbDRFIiwiZXhwIjpudWxsLCJwdXIiOiJibG9iX2lkIn19--a86bf4480d7fefbed6172fa1e1bc4751b516cec2/SGFP%20Billing%20Guide%20APRIL%202023%2002_May_2023.pdf 𝗥𝗲𝘀𝗼𝘂𝗿𝗰𝗲𝘀: 1) FHO Family Medicine Billing Practice Cases: kzbin.info/www/bejne/o6HNcqFvpqeXfas 2) Intro to Family Medicine Billing for PGY-1: kzbin.info/www/bejne/d6fIiJKCjtmkipo 3) Intro to Family Medicine Billing for PGY-2: kzbin.info/www/bejne/hmmTpYiVe655abs 4) How do Doctors get paid? kzbin.info/www/bejne/jmbYgJ54ZaeojZI

[@btrcyyl7393]

Thanks for the video! This is so helpful for residents and new grads. I have a few questions/comments: 1. K039: Can you clarify what you meant by this being "not an actual code"? I have heard conflicting things as to whether it can be billed with A007/A001 and what "dedicated" means. 2. Palliative special access bonus: the first level ($2000) is available to anyone including those billing FFS. The other bonuses are available to those in a PEM (not just FHO). 3. Q152: It is available to anyone including those in a FHG who do not meet min rostering requirements. People in a PEM including a FHO (who receive preventive bonuses) are not eligible. 4. Q888: Can more than 3 appointments be prebooked and still be billed Q888? If the phone lines open in the morning and the patients call in asking to be seen and they present later the same day for their scheduled same day appointment, is that a prebooked appointment? Do the same rules apply for weeknight after-hours? Or are you billing A007 Q012?

[@BreakingBadDebt]

Hey! See my answers below: 1. K039: So based on the schedule of benefits "Smoking cessation follow-up visit is the service rendered by a primary care physician in the 12 months following E079 that is dedicated to a discussion of smoking cessation". Dedicated means that the visit is for the purpose of talking about smoking cessation only. Realistically, patients will likely ask you about more things than what the visit is scheduled for so theoretically you can bill an A007 with a different diagnostic code for the other issue. BUT the reason why I don't do that is just in case one of the codes getting paid out (more likely the A007) and the other not. I would rather have an Out of Basket code like K039 paid out than the A007. 2. That's good to know! I don't do palliative so I don't usually bill those codes... 3. Yes, when I worked in a FHG I was able to bill Q152 as well. Good catch! In the SGFP document Q152 is for "FFS or PEM less than minimum roster size" 4. Q888: So this can vary across clinics, and there might be others who do it differently. For the first 3 slots they are offered as pre-booked slots and you bill A007+Q012 (in basket). If those spots don't fill up it won't disqualify all your subsequent walk ins from being billed as Q888+Q012. You just have to show that the spots were offered. Now if you have more 'pre-booked' callers than walk-ins according to the INFOBulletin "Scheduled visits rendered during the three-hour blocks should continue to be billed using existing Fee Schedule Codes and cannot be claimed under Q888A". I suppose your clinic can just tell patients you don't offer pre-booked appts and to just come in. For weeknight it would just be A007+Q012 if they're your rostered patients.

[@btrcyyl7393]

@@BreakingBadDebt So since AHCs are not prebooked even on the day of, do you HAVE to accept everybody who walks in in those 3 hours (lets say its the evening and you are open 5-8)? It could be totally out of control! Again, thanks for doing this!

[@BreakingBadDebt]

@@btrcyyl7393 At our clinic we stop accepting walk ins about 30min-1hr before the end of clinic to ensure that all the people who are waiting already can be seen. I agree that if you let people just walk in until 8pm then you'll likely be staying until 9pm finishing up!

[@Gertrude-z2h]

Hi Dr Zhou, I am currently doing some addiction work and family medicine (FFS). I am planning on joining a FHO for general practice. Could you speak a little more about how you are able to continue billing FFS for your addiction practice? What happens if the patients you are seeing in your addiction clinic are rostered to you or another physician within your FHO? Thank you so much!

[@BreakingBadDebt]

For the addiction practice, I bill out of basket codes A680, K680 so it doesn't negate other FHO doctors or eat into my FFS limit. Only in basket codes would do that. My addiction clinic patients are not rostered to me as they are in a separate practice altogether but even if they were, A680/K680 are out of basket anyways.

[@auslander1026]

So for home visit during weekday between it is B990 + B960 =63.9 🙄 Considering travelling and time with a patient it is less than the clinic visit... I had seen somewhere in the past it was 120 per pt... Same shoking numbers for minor procedures - 27smthing... It takes about 30mins on average to prep, do and close... Who does negotiate those rates (OMA?) and how often those numbers are reviewed (inflation... cough)?

[@BreakingBadDebt]

Hey just to clarify, those are the premiums, not the visit code. So let's say you see an elderly patient at home during the weekday, you bill A900 (complex housecall assessment) + B990 + B960 ($45.15 +27.50 + 36.40 = 109.05)

[@taherc]

Thank you for this talk. What is the minimum roster size for a fho?

[@BreakingBadDebt]

Hi Taher, there isn't a minimum roster size, just a maximum! But you have to consider if your roster size is too small, it might make more financial sense to do FFS or Income Stabilization: kzbin.info/www/bejne/mqWThZemgpaqrZY

[@labadee]

when we talk about units "per year"; when does that year start? is it january-january or a different time period? Thanks so much!

[@BreakingBadDebt]

It would be the fiscal year from April - March

[@nikhilanand3920]

Hi Steph - thanks for the amazing breakdown! I am considering transitioning from a FHG to a FHO. I was also thinking about the fact that I may not make much in my first few months of being in a FHO, since my roster size will be small. You mentioned that you did FFS initially. I plan on doing this too. I was wondering if you were a member of the FHO when you were doing FFS and was it contributing to the 57k cap? If you were not part of the FHO while doing FFS, how were you able to roster patients at the same time?

[@nikhilanand3920]

Also: 1. if my pediatric enrolled patients in a FHO go to walk-in clinics to get their immunizations done (18 to 24 months), can I still bill the tracking code? 2. do I need to meet a minimum roster size to bill the preventative bonuses?

[@BreakingBadDebt]

Yes there are 2 ways to go about doing this: 1) In my case, I was just FFS but I also got patients to sign the enrollment form. That way when I converted to a FHG and subsequently a FHO, I already had all the paperwork from before. I was not a member of the FHO and don't recommend doing both FFS and FHO work together b/c all FFS In Basket Codes will cause you to reach your 57K cap easily. As a FFS provider, you can't "roster" patients. 2) Income Stabilization is another way to receive income while you have a small roster. I had done a video about this here: kzbin.info/www/bejne/mqWThZemgpaqrZYsi=zFKW1vrXEcamnFAS

[@BreakingBadDebt]

@@nikhilanand3920 1. Yes you can bill the Q132 b/c it's you who is making sure they got it done and updating it on your records. 2. To my knowledge there isn't a minimum roster size, you just have to be in a FHO, FHG or any other PEM to bill the bonuses although those are going away in 2024.

[@nikhilanand3920]

Thanks Steph! Much appreciated

[@Lalouxox]

In regards to rostering patients, would you need to add the Q023A every time you bill? or is it just once? and once they are derostered, how do you let the gov know? is there another form that you send or is there an exclusion code? For Q codes in general, you can bill them with A or K codes? or it depends? For example, the Q015A for newborn episodic care, can you add that to an A007 for example? thank you :)

[@BreakingBadDebt]

Hi Leila, for the Q023 code you would only bill it 1x at your meet and greet (A007+Q200 (roster code) +Q023 (unattached premium)) as long as they meet the criteria in 20:46. To Deroster you bill the code Q402. Q codes can be billed with A or K codes: A007+Q015 is ok and I've billed that before.

[@Lalouxox]

@@BreakingBadDebt thank you :) your videos are tremendously helpful

[@auslander1026]

@@BreakingBadDebt Can you add Q200 post-factum i.e after patient signed the form? Sounds like it has to be both (form and code) for MOH to get that pt on the roster...

[@BreakingBadDebt]

@@auslander1026 Hey I've definitely billed Q200 after the pt signed the form. When I started out at my clinic, I was FFS so I had everyone joining my practice sign the form first. Then, I converted to FHG a year later, so to roster everyone, I just batch billed Q200 on all the patients who had signed the form.

[@nikhilanand3920]

Hey Dr. Steph, I had another quick question. For the prenatal care special premium, does this include P003/P004 for any patient? (Ex. If I do two P004 for one patient, and one P004 each for 3 other patients each). Thanks

[@nikhilanand3920]

Also, does the Prenatal Care Special Premium apply to both FHG and FHO?

[@BreakingBadDebt]

@@nikhilanand3920 Hey, the prenatal care special premiums is only for FHO practice. It is when you bill any P003/P004 during first 28wks GA for any 5 enrolled patients...so not for the same patient.