test 1 Flashcards
average app time
15 min
minor ass. app time
5-7 min
intermediate ass app time
10 min
annual health exam app time
20.40 min
initial prenatal exam app time
20-30
general prenatal visit app time
10 min
well baby visit app time
10-15 min
pap app time
10 min
counselling app time
30-60
patient rostering- what is it?
Process by which patients register with a family practice, physician, or team.
An ongoing relationship between the patient and provider
Key component in primary care models
Formalized though an agreement signed by both patients and providers
A commitment to each party
Core element of care
what/who is impacted by patient rostering?
health outcomes, physician-patient commitments, EMR’s, funding strategies, continuity of care, preventive care and chronic disease management, panel size
benefits of patient rostering?
benefits family physicians
-clearly define patient population, strengthens relationship continuity, needs of specific groups, identifies research and teaching)
benefits the patient
links patient formally to specific health care provider, timely apps, access to information- referrals, specialists, health services etc.
limitations of patient rostering
physicians- time resources, expertise, training IT support, patient has right to seek other primary care setting
captivated payment system- cant roster a patient who is already rostered elsewhere
info needed for a claim
Physician Registration Number Date of Birth Service Date Service Code Diagnostic Code Number of Services Price Per Unit Fee Submitted Accounting/Claims Number Payment Program (HCP, RMB, WSIB) Payee Referring Physician Facility Number Inpatient Admission Date Manual Review Field Independent Consideration Shadow Billing (for family health networks)
3 types of claims
1) Services covered under the Provincial/Territorial Health Care Plan
2) Reciprocal claims
3) WSIB
claim deadlines
Based on a monthly billing cycle
Claims received by the 18th of the month will typically be processed for payment by the 15th of the following month
When the 18th falls on a weekend or holiday, the deadline will be extended to the next business day
Claims received after the 18th will be processed for payment on a best effort basis and may not be processed until the next billing cycle.
file reject message
Rare report – does not happen very often
Indicates that Ministry has rejected entire claims file
Usually due to technical errors
Notified within hours of claim to allow for timely resubmission
batch edit report
Report is normally sent within 24 hours of the claim file submission
This is your receipt that the ministry received your file
However, it does not guarantee payment of the submitted claims
If claims are uploaded on a weekend, holiday or at month-end, the Batch Edit Report is delivered on the next claims processing day
error report
AKA: Claims Error Report
This report provides a list of rejected claims and the appropriate error codes for each claim
Normally sent within 48 hours – 72 hours of claim file submission
If claims are uploaded on a weekend, holiday or at month-end, the Error Report is delivered at the end of the next claims processing day.
group split remittance advice report
This report is only available to individual physicians within a Family Health Network (FHN) or Family Health Organization (FHO) for reconciliation of their own claims
group split error report
This report provides a list of rejected claims and the appropriate error codes for each claim
It is only available to physicians affiliated with a FHN or FHO.
remittance advice
AKA: Reconciliation Advice
This report is a monthly statement of approved claims
Normally delivered within the first week of the month
RA is produced during a three-to-four day period at the end of the month and is delivered when month-end processing is completed
rejected claim
Claim is rejected if it is missing any of the necessary information required to process a claim (ie: missing version code, expired health card, missing assessment/diagnostic codes, etc.)
Each rejected claim will have a code for rejection or underpayment – need to look up code and correct
Try to correct and resubmit as quickly as possible
Have maximum 6 months to make corrections and resubmit claims
stale dated claim files
All claims must be submitted within six months of the date of service
Claims submitted more than six months following the date of service must be submitted as a stale dated file
Single claims can be submitted with other claim files but must be identified using the manual review indicator
Supporting documentation must be faxed to your local claims services processing office.
