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OHIP Billing Tip #47 - Psychiatric Premiums

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How to add psychiatric premiums to your OHIP claim

For Psychiatrists, there are various premiums that may be applicable to you.  These are:

  • Acute Post Discharge (K187): extra 15%
  • High-risk community psychiatry care (K188): extra 15%
  • Urgent Community Psychiatric follow-up (K189): extra $200

To properly bill these premiums, you need to document the patient’s discharge, and/or suicide attempt date. We have implemented a feature to assist you in tracking these dates and notify you if you may be applicable for premiums according to the rules from the OHIP Scheduled of Benefits. 

Follow these instructions to use this feature:

1. Enable the Psychiatric Premiums under MY PREFERENCES (don't forget to SAVE the setting at the bottom of the page)

Enable psychiatry premiums selection

2. You will notice two additional fields when you create a new claim. You can enter the discharge, and suicide attempt date as applicable. Our system will remember these dates the next time you bill for the same patient.

New medical claim window with suicied attempt date for psychiatry premium calculation

3. When you bill the same patient and use specific Psychiatry service codes (A190, A191, A192, A195, A197, A198, A695, A795, K195, K196, K197, K198), our system will check against the discharge and suicide attempt dates and warn you if you are eligible to bill premium codes. The rules are as follows:

  • Suicide attempt date =< 6 months ---> K188 is applicable
  • Discharge =< 4 weeks --> K187 is applicable for only codes: K195, K197, K198
  • Discharge =< 4 weeks and suicide attempt date =< 6 months ---> K189 is applicable for only codes: A190, A195, A695, A795

Warning that you may be missing out on psychiatry premium

4. Upon noticing the warning messages, you can then enter the applicable premium codes.

This process not only helps you earn more but also saves you time by eliminating the need to calculate if a premium is applicable. As always, please familiarize yourself with rules from the OHIP Schedule of Benefits section A114 before applying any of these premiums codes.

For more billing tips, please check out our OHIP billing tip library.

Questions? Check under the HELP tab or send an email to support@mdbilling.ca.

Thank you,
MDBilling.ca

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