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| ministry of health & long term care |
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| Most Responsible Physician |
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| Royal College of Physicianss and Surgeons of Canada |
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| Ontario Health Insurance plan |
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| manual claims must be submitted by... |
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| e claims must be submitted by the ... |
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| Claim payments are sent out on the .. |
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| 4th or 5th of the following month |
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| Claims must be submitted.... of service date |
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| Payees are P or S. These letters stand for |
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| Reciprocal Medical Billling |
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| Reciprocal Medical Billing is... |
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| an agreement between provinces to provide payment for health care, Quebec is excluded. |
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| Workers Compensation Board |
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| How is the service code determined? |
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Definition
| By direct contact with the Physician (consult/procedure) |
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| Most Responsible Physician or his staff |
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| The service date is the... |
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| day consult/procedure was performed. |
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| Time to allot for a General Assessment... |
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| A Pre-Op visit is also this type of visit... |
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Definition
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| How often can a Physician bill for a General Assessment per Patient? |
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Definition
| One per Year per Dx. or Two per Year if unrelated Dx. |
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| If 90 days has passed since the date of last General Assessment and patient needs to be admitted to Hospital. Can a 2nd General Assessment be billed? |
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Definition
| Yes. A Hospital Admission Assessment can be billed. |
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Term
| What does the Physician do in a General Assessment? |
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Definition
| Hx of presenting complaint (must include Hx. of presenting complaint, family medical Hx., past medical Hx,and a functional inquiry into all body parts and systems |
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Term
| When should you bill for a General Re-Assessment? |
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Definition
| Patient returns within one year for same complaint. |
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| How often can you bill for a General Re-Assessment? |
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Definition
| 2X per year per patient per diagnosis |
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| What does the Physician do in a General Re-Assessment? |
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Definition
| includes all the services listed for a general assessment, with the exception of the patient’s history, |
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Term
| Annual Health Exam is a ... |
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Definition
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| what are the limitations to billing for an Annual Health Exam? |
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Definition
| 2 years of age +. Patient presents with no complaints. 1x per year. |
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Term
| If Physician does a Pap Smear during an Annual Health Exam in his office, Can he bill for it? |
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Definition
| The Dr. can bill for the tray only. The procedure is included as part of the General Assessment fee. |
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Term
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Definition
| initial General Assessment and subsequent assessments during the first 10 days of life. |
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| If a well newborn is transferred to another institution, can the new Dr. bill for General Assessment? |
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Definition
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| is there any limitations to billing for assessments on a low birth weight/newborn or infant? |
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Definition
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| What is a Well baby visit? |
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Definition
| Examination of weight/growth and development of a well baby up to 2nd Bday. |
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Term
| What is an Intermediate Assessment? |
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Definition
| Extensive examination of specific complaint as needed to make a Dx. |
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| How often can you bill for an Intermediate Assessment? |
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Definition
| Whenever patient comes in for a general visit. (many times per year) |
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| What is a minor assessment? |
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Definition
| a fairly simple and quick diagnosis. |
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| How often can you bill for a Minor Assessment? |
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Definition
| Once per Day. Unlimited annual. |
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Definition
| Initial Dr. requires the opinion of a second Dr. It must be in writing and contain the original Dr.s Provider #. |
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| What is a Special Surgical Consultation? |
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Definition
| A surgeon is referred to by another Dr. to conclude whether or not surgery is required? |
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| When can you not bill for a Chronic Disease Premium? |
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Definition
| Visit is other than an assessment, takes place in Emerg, patient is admitted to hospital or LTC. (not all specialists can bill for Chronic) |
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| When a procedure is sole reason for a visit, you would bill... |
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Definition
| G700, the basic fee-per-visit premium for those procedures marked (+) regardless of the number of procedures carried out during that visit |
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Definition
| Dr was called in and is required to travel to other location. |
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Term
| when do you use a W prefix? |
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Definition
| LONG-TERM CARE NON-EMERGENCY |
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Term
| Type 1 Admission Assessment? |
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Definition
| a general assessment for admission |
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| Type 2 Admission Assessment? |
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Definition
| general re-assessment following admission |
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| What is a Type 3 Admission Assessment? |
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Definition
| general re-assessment of patient who is re-admitted t min. 3 day stay in another institution. |
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| if a physician is already in the institution and is asked to assess one of his/her own in-patient what prefix would the service code contain? |
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Definition
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| if a physician is already in the institution and is asked to assess an in-patient who is unknown to him/her.what prefix would the service code contain? |
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Definition
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| Can an E code be billed alone? |
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Definition
| No. must be an add in. the exception is for procedures of the eye. |
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| When do you use a C prefix? |
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Definition
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| When do you use a K prefix? |
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Definition
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| counselling is billed by the unit. What make a billing unit? |
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Definition
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| What is the Assisting Dr.s fee based upon? |
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Definition
| Basic Unit(as per the SOB)+ Time Unit (time in surgery) X 11.40 |
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Term
| How many units of time is one and half hour surgery? |
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Definition
| 8. 4 units for first hour. after that time units are doubled. |
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| What suffix would be on the Assisting Dr. service code? |
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Definition
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| An assisting Dr.s responsibilites include... |
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Definition
| Prep of the patient for the procedure, Performing procedure,any related assessments, procedures, or therapy, discussing any advice/information with patient |
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| if surgery takes place Mon-Fri evening before midnight. the Assist can bill an additional... |
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Definition
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| surgery takes place Mon-Fri evening after midnight. the Assist can bill an additional... |
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Definition
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| Sacrifice of hours premium cannot be greater than X% of total months billed services. |
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Definition
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Term
| can you bill a special visit for a non referred/transferred obstetrical patient |
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Definition
| yes.obstetrical delivery with sacrifice of office hours for first patient seen. This is the only exception. |
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Term
| what is SACRIFICE OF OFFICE HOURS ? |
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Definition
patient’s condition are such that the Dr. makes an
immediate, previously unscheduled emergency visit to the patient at a different location. |
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| what are time limits of special visit premium? |
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Definition
ten (one first patient premium and 9 additional patient premiums) during the
same special visit |
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Term
| the prefix to the service code to for a special visit to a non-professional setting is? |
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Definition
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Term
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Definition
| Independent Operative Procedure. Z code. |
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| When more than one procedure is performed under same anaesthesia, How much is billed? |
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Definition
| full amount to the major procedure and 85% of benefit for 2nd. |
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Term
| if 2nd unrelated procedure is performed, can the assist bill for 2 procedures. |
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Definition
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| if surgery takes place Mon-Fri evening before midnight. the Surgeon can bill an additional... |
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Definition
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| if surgery takes place Mon-Fri evening before midnight. the Surgeon can bill an additional... |
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Definition
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Definition
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Definition
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| how many pre-op assessments can a dr claim in one years |
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Definition
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Term
| what is the max you can bill for counselling in one year? |
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Definition
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Term
| what must be recorded when billing for counselling? |
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Definition
| start/finish time must be on both patients record and the daily scheduler. |
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Term
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Definition
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| how many partial assessments can a specialist bill annually? |
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Definition
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| Referral letter must contain... |
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Definition
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| a dr can claim X for first procedure and X for second procedure |
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Definition
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| 4 types of Consults are... |
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Definition
| Consultation, Special Surgical Consultation, Repeat Consultation, Limited Consultation |
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Term
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Definition
| specific complaint that needs to be examined by reviewing all systems of body to make Dx. |
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| General Assessment limits |
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Definition
1 per year per diagnosis.
2nd permitted for different diagnosis |
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| General Re-Assessment defn |
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Definition
| Patient returns within year with same complaint. |
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| General Re-Assessment limits |
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Definition
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Term
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Definition
| Dr. examines specific system for Dx. and also performs sm. procedure. |
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Term
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Definition
| Used for most family dr appts. Dx is quick and simple |
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| Hospital Subsequent visits |
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Definition
one per day by MRP first 5 weeks.
3 visits per week for weeks 6-13
6 visits per month after 13 weeks |
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| Concurrent Hospital visit |
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Definition
Specialist fu care.
4 visits first week
2 visits thereafter |
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| sequence of billing when more than one |
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Definition
| Visit code, procedure code, any extras. |
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Definition
| not major procedures and are pre-planned |
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