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OHIP Billing Tip #18 - Automation Codes

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Automation Codes

By using MDBilling.ca’s software automation you can save time, improve accuracy, and ultimately, maximize your monthly revenue.

Important: please familiarize yourself with the Schedule of Benefits, and how the automatic codes work. If you are not sure, do not use the automatic codes.
Here are two examples:
 

  1. RE/ASSESSMENTS (A[][]XA) – "Patient Review" or "Follow Ups"

The MDBilling.ca automation allows for a physician to bill a single code for a “follow up”, and our software will automatically choose the highest paying assessment based on existing codes previously billed in our database. The algorithm will choose the highest paying re/assessment code first, and subsequently bill assessment codes in decreasing fee value, taking into account that each re/assessment code has a limit of the number of times it can be billed per every 12 months, as per the rules from the OHIP Schedule of Benefits (section GP14-16).
The rules for the automatic re/assessment codes are as follows (replace [][] with your 2 digit specialty):

  • Medical Specific Assessment:
    A[][]3 max of 1 per 12 months, or 2 if the second visit is an unrelated diagnosis.
  • Complex Medical Specific Re-Assessment:
    A[][]1 max of 4 per 12 months, or any combination of A[][]3+A[][]1 to a max of 4 per 12 months
  • Medical Specific Re-Assessment:
    A[][]4 max of 2 per 12 months
  • Partial Assessment:
    A[][]8 thereafter

 
You no longer have to determine which re/assessment code to bill. Just bill A[][]XA and we will automatically choose the correct code for you.
Please note the automation code only works for “A” prefix codes, but not with “C” prefix codes.
You can find your two digit specialty under:
PREFERENCES - MY DETAILS - Specialty (see screenshot below)
 

  1. INPATIENT VISITS (IPTMA, IPTXA) – "Rounding"

When rounding on patients, the service codes will differ depending on the number of days the patient has been admitted. The MDBilling.ca automation allows for a physician to bill one code for rounding, and for our software system to automatically choose the correct (and highest paying) code allowed based on the admission date entered.
The algorithm will choose the codes as follows ([][] represents your 2 digit specialty discipline): 
IPTMA - MRP Inpatient visits.
C122A+E083A (day after admission)
C123A+E083A (2nd day after admission)
C[][]2A+E083A (1st 6 weeks)]
C[][]7A+E083A (7 - 13th week) 
C[][]9A+E083A (13th+ week)
 
IPTXA - Inpatient visits
C122A (day after admission)
C123A (2nd day after admission)
C[][]2A (1st 6 weeks)
C[][]7A (7 - 13th week)
C[][]9A (13th+ week)
 
Please find more automation codes by logging into our portal -> HELP -> “Automation Codes”.

There is also a video tutorial that teaches you how to use Automation OHIP Code

For more billing tips, please check out our Billing Tip Library.

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

 

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