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Doctor bill format for NPOs

well listen I I am going to throughout this interview um going to ask questions that I hear from students and many times they're too embarrassed to ask so let's get to the real questions people ask me all the time doctor are you getting money to give me this Statin medication are you getting paid to diagnose me with hypertension I said time and time again on the Channel I want more people to get into Family Medicine how's it going everybody welcome back to the channel my name is Juna AKA Dr calano a few of you might have seen my videos before basically I am a new family doctor that going to be starting full-time practice in only a couple of weeks and for today's video I've told a few people that have watched the channel before what I really wanted to do ahead of starting practice was to try and bring on a professional someone that could help us out in terms of managing a practice and managing a small business because one of the things that I've heard from students time and time again is that throughout your medical training there is a lot of emphasis is placed on the medical learning and it's great especially here in Canada and the United States but a a common concern is that the financial education the business education is not something that is consistently enforced in all cases so I thought that instead of just repeating the same thing over and over again we might as well do something about it and in that regard I brought on Damien today who was so awesome to decide to come on daman's from Doctor care full disclosure uh as a new grad going into practice I am working with Dr care I saw the Vault myself because I didn't feel like I was in a strong enough position to be able to handle managing a business by myself in the beginning and that's why I reached out to someone that could help out with that and uh Damen feel free to introduce yourself John LCA always a pleasure great chatting with you again I'm Damian from do care I'm the regional director for Southwest Ontario and today I'm actually honored to be part of NextGen MD's next little Web video cast um a lot of great topics to come up ahead my main role in the organization is I meet with tons of Physicians either new to Family Practice new to Ontario um practicing for 10 20 30 years coming close to retirement and there's always the same sort of struggles challenges and misinformation as well too which we're going to cover a lot of that today in our discussions John Luca and myself a lot of them in regards to you know what's it really like getting into Family Practice What enrollment models are there what type of areas do doctors want to focus on is there more of a work life balance approach is there more of a lucrative approach depending on what model suits people and the idea is that we're going to have those discussions today in regards to giving you more information more access to the content and materials that we provide to thousands of Physicians across Ontario let alone the country itself um I've had the pleasure of working with do care for just about three years now but the company's been around for about 11 years so Johan LCA thank you once again for having me I'm looking forward to our discussion today awesome Daman listen I'm going to be honest with you right at the outside I I do have an agenda for this video I I said time and time again on the Channel I want more people to get into Family Medicine it is a profession that I love that I've trained for years and years to get into and I hate hearing students come to me and say that they don't want to get into family medicine because they're concerned that they're not going to be able to keep the lights on in their practice and certainly on the news I see a lot of that I also don't want students to have to come to me and say that they don't want to get into the field because they can make a lot more money in another specialty and that's what I'm hoping that you're going be able to help some people out with today I have some questions that I had for myself and I've asked you already but I want other people to hear them and guys if there's anyone that's watching this video today and you have more questions anything that you think Damien or myself could help you out with you're welcome to leave it in the comment section below and then we'll I'll put in some other things too and resources that you could look up because there's a whole bunch of things that you could read about for yourself why don't we start from the basics then okay you're a new physician going into practice you're just graduating your Family Medicine Residency why don't we go ahead and talk about the different practice models and your options for which one you should get into and what you can do yeah absolutely so there's a couple of options to choose from and I'll give a brief little description on what they sort of mean and what they allude to from a day-to-day perspective one that's pretty obvious right off the bat is the fee for service physician it's pretty much as it's stated um every time you provide a level of service you get paid for that service you don't necessarily have a roster or panel of patients um you kind of work whatever hours you feel you work at certain clinics whether it's one or multiple types of walk-ins not really a lot of incentive towards it um as opposed to the other models we'll discuss that are more Family Practice oriented okay the next model I want to briefly touch upon it's the comprehensive care model model okay this is sort of like a oneman family practice it's kind of referred to as the CCM model which probably some of your viewers are already in a CCM model um or probably applying to the Ministry of Health to get into a CCM model it's essentially one of the steps to building a roster and this is a panel of patients where you're essentially going to get some capitation for it so not only will you still build fee for service sort of every level of um visits that you provide you build the codes ingly in your EMR and you get compens for those visits you're also going to receive a little bit of capitation as well this is an incentive to doctors so that way that they provide ongoing comprehensive care of these patients um they find that the more attention they get from their doctors in regards to ongoing care with the same practitioner using the same health records they're going to do much better off later down the line where the fee for service model patients may not have an assigned family doctor and what ends up happening is they're bouncing from different Physicians and they're not getting Continuous Care lack of Continuous Care can lead to other problems on the medical side which John Luke I think you would know much a lot about that and the idea is we want to have more of a comprehensive approach CCM is like a family dock of one I'm Damian can I just quickly interrupt for a sec I think that's the first big distinction there feif for service is you are billing for the people as they come in I see someone I Mark the direct bill after that versus capitation is you are enrolled with me and we have a longitude udal relationship and I am getting a payment to see you many times throughout the year basically and it's all kind of contained in what we call capitation is that fair to say absolutely and even to Branch off on that point I'll use myself as an example Right male in his 30s generally healthy I might not even have to see my doctor for a couple of years but because I am registered I'm rostered to that family Physician's practice the ministry will still pay you the capitation whether I come or not so there is an incentive as that Beyond if patients are healthy you're still going to receive some payment and if they're not and they have to come in for the usual checkups or for whatever the comprehensive care is you will also paid fee for service above and beyond that capitation absolutely great and at least in theory as a family doctor that incentivizes me to keep you healthy because if I can keep you healthy then I don't have to see you over and over again because I'm getting paid the same thing so at least in that sense the way I interpret it is I am rewarded for providing you with great care absolutely and let's keep that note as we look at the next models because they all focus on that as well but they get more and more lucrative but also more and more incentivized as we go up the chain the next I want to Pivot towards is the family health group model okay this is essentially a group of three or more doctors where they're sort of linked they might be under one uh practice themselves they might be in one medical building but the idea is that their health records for their patients are all stored in one place and the concept is John Luka if you're my doctor and you were away this week but I had an issue and one of your colleagues was available your colleagues can still offer Continuous Care as well they'll have access to my records my charts so there's no interruption in care for a patient like Damian and there's further incentives to it the models are very similar between CCM and fig but the idea is you get a little bit more you get some premiums for your rostered patients some very basic codes like General assessments intermediate assessments mental health uh General counseling you'll get an extra 10% on all of those visits for rostered patients in the Fig because you're collaborating with other doctors where the CCM model doesn't really see that 10% incentive because you're kind of like a family health group of one so if you're willing to work with other doctors expand and work in a family health group um you still get paid fee for service for all your visits you still get capitation for having those patients rostered but you're also going to get certain bonuses and incentives beyond the CCM solo doc level um one of of them as well that differentiates between a CCM model and a fig model is if you have bipolar schizophrenia patients roster to the practice there's incentives and bonuses for a few thousand dollar each year that's available to the Fig level not the CCM level so important thing there there are different bonuses depending on what particular group that you're in absolutely not much variance other than that but the idea is um if you're looking to work with and with other doctors and it's great for patient care it's great for coverage on yourself and also there's added incentive in the Fig model too got it well listen I I am going to throughout this interview um going to ask questions that I hear from students and many times they're too embarrassed to ask so let's get to the real questions I myself I'm going to be working in a faux model that's my own practice I'm working with a bunch of other doctors uh we'll have my own office and there'll be four of us working together and students ask me which one's the best one which one should I do fee for service should I do a fo how do I decide that yeah great question a lot of it comes down to what is your practice style going to be what do you want to get out of your practice so a lot of what we do at Doctor care is we provide income analyses for anybody whether it's a new graduate new to the province maybe they're in a foe they want to go to a fig maybe they're in a fig and they're better off in a foe let's talk about the foe Model A little bit and then go into deeper answering that question on what suits everybody best so the model is another sort of Blended salary and payment model where the capitation payments much larger about 80% of a faux doctor's income is going to come from the capitation for their roster okay they're probably going to be working with somewhere around right now the ministry requires about six doctors or more in a fox some of the Legacy foes might have groups of about four five but the idea is it's a bigger group you get more support you're offering after hours amongst the group to give that level of care to patients so it's further continuity and there's going to be further incentives in that regard as well too because capitation is paid every single month whether you Bill or you don't bill this is an added layer of flexibility or work life balance in the sense that you work fee for service CCM or fig if you don't show up to work if you're away or if you're sick you're not getting paid for that day because essentially you didn't Bill anything the capitation is much much much smaller in the CCM or fig model where the faux model is much much larger once again about 80% of your income will be determined by your capitation in the F okay on top of that you still get to charge for your Billings um we'll probably get into a little bit about what the type of codes are in the foe focusing on out of basket coat still being paid at the full fee for service value so there's added incentive if you're very good at billing you are going to get compensated more in the faux model because the capitation is larger and filling the full fee for service value out of basket codes yeah for in basket codes General assessment uh you'll get about 19 20% of the visit so it's still worth your time but we'll talk about a little bit of tips and tricks on how to get the most out of your time when it is dealing with out of Basket in basket codes lastly their can I ask a quick question about that I I I think that's a really important topic I just want to go ahead and let everyone know you know a lot of my patients are curious about this stuff and I think it's awesome for the general public to want to know this stuff too people ask me all the time Dr are you getting money to give me this Statin medication are you getting paid to diagnose me with hypertension that's that's not the case that's not how we get paid these are the only two models that are providing payment for us right now there are bonuses and things for making sure that we actually see sick people but I think one thing that's really important is that 19% number that you just talked about if I see someone uh in my faux model and I build my a007 which is an intermediate assessment uh I'm only making 19% of the value of that code which is somewhere around $40 that that's not too much money per individual visit the majority of it comes from the fact that I am seeing you on a long-term basis that is absolutely correct and that the the overall goal is that if we're able to give good Continuous Care amongst a large group of doctors we have six 10 to 12 even foes of 40 doctors Dam has access to all of these Physicians daman's Health should be continuous and in the long run you should be generally healthier getting this Continuous Care when he's in his 60s and 70s right and not bog up the emerges later on that's what the premise of it is right it com patient care and we're incentivizing that by banding together and working together now now I would like to take that what you just said and I think this is a great Segway to the next thing in my opinion at least for me the fox was the best option everyone could go ahead and choose what works best for you if you're going to see 100 patients a day then yeah consider a fee for service but at least for me I would rather provide that ongoing care and the full model works well in basket versus outof basket codes is something that you talked about quite a few times now maybe just talk about what the difference is between the two absolutely so at a very high level in basket codes are typically for General appointments or general assessments like if Damian shows up you had a sore throat cough cold headache maybe pain you're going to build something like an a007 it's probably the most commonly buildt code in the schedule of benefits there's no time requirement for it and it's pretty much I spent anywhere from five to 10 15 minutes there's no time requirement but it's kind of the quick In-N-Out with the patient you give them what they need and they're on their way other in basket codes would include General counseling so if you spend more than 20 minutes with the patient you're going to get a higher premium it's a almost double the value of an a007 but there's a Time requirement so you're gonna get that's the k013 am I right about that that is correct for General count k013 nice do your homework which is good I'm I'm trying to pick it up all right other ones like mental health I see a lot of doctors have areas of Mental Health with their patients that's also another valuable code to build too and those are generally uh in basket also physical assessments a003 General assessments full history of the patient full analysis periodic Health visits there's a lot they're all staggering now because they're General appointments in the faux model you're already getting a large capitation the average capitation per patient in the foe is about $200 per year per patient okay it'll range for generally young and healthy patients being around $80 a year per patient and then patients like my grandmother uh in her 90s female you get about $650 a year before seeing them or billing anything so the important point is the older someone is and there's a few other modifiers as well obviously the young and healthy people are not worth as much money as the old and sick people because you need to see those people a lot more to give them good care absolutely and there's an incentive towards that also and so the idea look at Damian I like using myself I'm a male in my 30 my capitation is about $100 so they're going to say he might show up two times this year for a sore throat or an issue like this we're already his capitation because we know he's going to be showing up if I don't doesn't matter you still get my capitation but if I do you're gonna get what's called Shadow billing it's a common term flow model that's that 19.4% you receive for doing an in basket service okay so you're still compensated for your time but the bulk of it's going to come into capitation MH now let's pivot a little bit let's talk about out of basket this is for complex care codes so things like diabetes if they're smokers paliative care prenatal if you have fibromyalgia patients or um diabetic patients as well okay because we don't know if Damian is diabetic okay if we don't know if Damian has fibromyalgia we can't quantify that into his capitation based off of his age and his sex because those are the two factors that go into determining a patient payment what the ministry will do is just say if you Bill him as a diabetic patient because we don't we're going to pay the full fee for service value there got it the reality is that doctors are not fully aware or confident in how to or when to build these out of basket codes so the issue is that they end up leaving about $40,000 a year on the table Yeah because focus a lot on the in basket coats what we want to do is we want to help doctors be confident in their Billings confident and get compensated for all of those diabetic checks all of those questions with smoking the prenatal codes if they do pallative work um if they are doing any hospitalists or home visits home visit is a bit of an in basket code but again we get a lot of questions based around that because they're defaulting to the a7s or the K13 when they could be building more accurately billing smarter harder let me just pause you there because that is the biggest that was what shocked me being in residency right you could have two doctors that are doing the exact same work they are actually providing these services and they are doing good patient care and everyone's happy with them this is one doctor and I know you said $40,000 I've seen doctors that don't know the right codes that are choosing to default to these lower paying codes even though they're doing the work and they're missing 50,000 60,000 or more and I've seen it and it's unfortunate because then what happens is that $70,000 in some cases goes towards your overhead and that goes a long way towards that and I think that one of my you know reasons why we're doing this is because if I could get more people to take advantage of the work that they are actually doing cover the cost of their overhead that's already one less barrier to getting people into Family Medicine so for that thank you for kind of highlighting that and that is making sure that you're seeing the patients with diabetes your patients that are smokers your patients with fibromyalgia these are people that need care and you should be seeing them and you should be getting compensated for the work you're doing yeah absolutely and um it's it's a challenge it's probably the biggest struggle because time is always tied to this right like how much time am I going to spend how confident am I everybody kind of defaults to the path of least resistance we do a very good job at assessing practices and identifying what the doctors are doing very very well and encourage them to keep doing that but then we also learn a little bit about what they're doing but not getting fairly compensated for and it tends to be quite a large Delta early on when we do these analyses this happens B level it happens at the Fig level it happens at the CCM level I would even argue it happens at the fif for service level right without any capitation because again you might be missing out on the list is long but things like STD STI counseling that happens at the feif for service level whenever they do screenings there are special codes for that that pay higher premiums regardless of in basket out of basket for those dogs so we always encourage them if you have questions like we have a very expansive of library of resources online reach out to us inquire to doctor care CU as much as every practice is very unique because we've dealt with thousands of different Physicians and thousands of different types of scenarios we've kind of seen it all we've kind of touched upon everybody in their practice Styles and we can almost kind of guide you in a sense as to is this the focus that you want to go towards this is the upper limit and we want to show you what the upper limit is because you might actually take on more patients or you might get into long ter care or you might actually start doing more paliative work because now you understand the potential of income that you're not wrong again 50,000 plus is something that we have seen in discrepancies and it does go quite higher depending on size of practice age of practice Etc got it and yeah that that was actually my next Point can we touch on some of these high kind of um need to know codes that people are missing and I think we've done a good job so far is is there anything else that you would tell you know the the emerging physician to look out for in terms of outof basket codes that they should not be missing and they should pay attention too yeah absolutely right when we get started with any of our positions we always like to put a heavy emphasis on the outof basket code k30 this is the diabetic visit code out of basket $41 now I think since the latest rate increase from theoh but it triggers a $60 bonus when you see a diabetic three times in a row in year if you're not billing this code forget that you're charging at a lower rate you're leaving a $60 bonus for each patient who you're three times for diabetes most doctors are seeing their diabetics anywhere from three to four times in a year so essentially they could be missing out on that code um ideally what you want to see is that um about 11% 12% of your practice is probably diabetic so any doctor has from 100 to 200 plus diabetic patients I've done the numbers some doctors are leaving just 14 to 15 even $20,000 in not billing the proper diabetic codes and getting their bonuses not trying to work more not trying to add more visits they're just not billing appropriately and they're eligible for that so we want to change that mindset first as one of the D could I use you as an example because this is massive we we just said 30-year-old male you're worth about $100 in capitation right let's say you had type two diabetes and as your doctor I should be seeing you at least three times a year to check in on your sugars to make adjustments to your medication whether or not you're on insulin I'm going to be seeing you for those times anyways so if I'm not billing those codes I'm missing out on $40 $40 $40 $120 plus that $60 bonus for going ahead and actually seeing you those times that's $180 brings your total up from 100 to 280 and just to drive that point home that's why that's so important that you take advantage of it absolutely and that's the one advantage if we're going to Pivot a little bit to the faux model there's no other model like fig or CCM that will pay you $100 in capitation for Damian so even if you're an accurate biller in the Fig model the CCM or the feif for service model the most money you'll make is in the faux model granted Damian in that scenario because the capitation is large and the out of basket portion is always paid in full great example okay good any other ones yeah let's go through a couple more smoke is a major one the smoking sensation codes e79 it's an add-on code and it's sort of phase two that we look at once doctors get very very strong and comfortable with diabetic Billings yeah we see hey Doc you only build one smoker in the last six months I'm pretty sure you have a lot more than just one and they laugh and they say you're right I always forget about the e79 yeah it's an extra 16 that you can add to codes like a007 K5 k 013 Etc and the idea is what ends up happening is that it'll boost the value of an in basket code whether it's Fe for service or whether it's paid at that shadow billing rate by a full $6 about 16% of a Doctor's practice are smokers so essentially you shouldn't be billing just one you could be billing 200 to 300 patients in an average practice at that $16 we know it's happening I don't even ask doctors if they ask I know they do it my family doctor asks me but they're not filling for it when they're submitting their claim so again bringing more light bringing more confidence building the smoking again the takeaway here is that people that smoke smoking as a as a determinant of someone's health is costing the system I don't even know how much money per year Millions around the province so incentivizing us to talk to people and trying to get them to stop smoking cigarettes big way to both save money and improve People's Health I'm just trying to stay aware of the time I'm going to move things on we'll put a list of a whole bunch of out of basket codes if that's okay with you abut my last question and then I'll throw it to you I hear from people all the time that they're like hey I'm first year in medical school and on the one hand I would like to do family medicine but on the other hand the neurosurgeons I hear they're making all this money can can a family medicine doctor make neurosurgeon levels of money and and I'll tell you just at face value the answer is usually no usually I I can't cover that full Gap but in in the spirit of trying to maybe shrink that Gap as most as you can and things to remember guys that there is no limit no one's saying that as a family doctor you need to work 20 hours a week 30 hours a week the neurosurgeons are working many many hours and you could choose to work those hours in Family Medicine in a hospital in an emergency department doing paliative medicine like Damien had already talked about before Daman if someone said to you as a family doctor how do I close that Gap how do I provide good care but also make more money what do you tell these people yeah great question we get it all the time I've had the um the honor of assessing probably close to a thousand practices and it really comes down to what the approach is if it's a faux doctor the best way is to grow the roster increase your capitation we know 80% of that is there but I see a lot of the high earning doctors to get additional income they're going to be focusing on long-term care or they're going to be doing a portion of hospitalist work or they're going to be doing like home visits for like retirement homes Etc all heavily influenced and heavily incentivized areas of practice that I've personally seen very very high yielding returns some as high 600 700 $800,000 a year in anual income on the Fig level we have the doctors that are like hey Damian I just want to work six days a week 12 hours every day maybe that approach works better it always comes down to Let's do an income analysis for you we offer a very nice complimentary assessment and it's how we gauge where the doctor's at where they want to go and we say give us a number and then we can work backwards how many rostered patients you need how many visits you need to do how many days a week that you want to do and we kind of find a sweet spot I also want to throw a little sidebar in Block fee uninsured services for private bildings this is something the Ontario medical association they had a wonderful webinar on it earlier this year and their sort of um Board of Physicians were advising that you're doing yourself a disservice by not offering a block fee at your practice not having your time valued because just because it's not covered by OIP because it's privately insured you should be letting your patients know that this comes out of cost like for sick notes Etc we tend to Physicians are leaving about 30 to $60,000 a year just by working for free for private so that's a little bit of a sidebar but sure there is the possibility to make those neurosurgeon numbers depending on what kind of practice style you have and it comes down to analysis good list thanks so much for sharing that the last little bit I I have about 4 minutes allocated here you're such a library of knowledge here I've only asked you so many questions and guys the good thing is that you know I would just say even if it's not doctor care I I think we could both agree with this if you feel like you don't know a lot of this stuff I would recommend that you get involved with someone that's been through this before especially in your first year because as a new grad if I didn't have Damian to ask these questions to I probably would have lost a lot of money i' done some calculations for myself my overhead is quite expensive I would have lost thousands of dollars a year ask people these questions because there are great people that ask these questions too Daman you got four minutes give us any tips any last things that you wanted to say anything you wanted to share with the viewers yeah um the the idea is that we actually um really do advocate for our family physicians we do appreciate the work you do and I want to also allude to the huge efforts that people like yourself and your colleagues provided us coming through covid right you guys stood firm you guys helped us and unorth times and you guys stuck there the idea is that um we want to help try and give you that time back leveraging technology finding ways to automate relieving administrative burden are all tied to increasing your income your comfort your work life balance and it'll also improve patient care um the idea is that you want to be very well knowledged when it comes to the work you're doing and how you should be fairly compensated again billing smarter rather than working harder is going to be Paramount to your time quality of life and income that you're going to earn um the other thing that I want to also mention is that we have a wonderful resource Library Online it's accessible to the general public but we get a lot of doctors they subscribe to our newsletters they get monthly updates on what's changing in the Ministry of Health what are the new codes what are bonuses that are available constant reminders I would encourage Physicians to take a look at our Content Library and even reach out to to us like I said we offer complimentary assessments we offer just a a resource of specific questions you have about billing your practice model are you new to practicing do you need a billing one-on-one session because you're new to Ontario we have a huge team of billing experts and professionals that are here to help you because the idea is that we want to have our doctors backs because the doctors have all the backs of the patients that they support and take care of so we're here to help a thanks so much for that if there's one thing that I kind of want to say and takeaway here is that in my area I am walking into a practice where the doors have only been open for about a month and a half coming up on two months me telling people that I'm going to be accepting applications in some estimates there's about 10,000 people in the region without a family doctor right now it's been an area where it's been hard to find a family doctor for a long time I would like to see more people work very very hard I I want people to be in there and actually seeing their patients and doing the things that they need them to do because I think there is no there's no negative to having more of the smartest people that we have come into family medicine to help a community and I I know there's a whole bunch of different opinions about this stuff the more I talk about finances the more I see it in my comment section as well I want people to feel empowered to go into family medicine and and really that's why I was really happy to have Damian and Dr K on today I cannot kind of encourage you guys enough to ask more questions leave it in the comment section you could join groups online of doctors that are getting into practice there's a Facebook group called The First 5 years of Family Practice if you want to talk to colleagues and working out things because not a not a a period of four to five months goes by without me tuning into Global News and seeing that another family doctor had to close their office and I hate seeing it and it's not a position that I ever want to be in for myself because I know that I'm going to let 2,000 people down without a family doctor so I think that's how we fix the problem that through one way or the other we're here now and now it's how do we get the people in this space to slowly start and fix that absolutely and to further that we're here to help so whatever we can do please reach out awesome thank you guys very much we'll see you all on the next one thank you Daman for coming out L always a pleasure thanks for having me as well take care no problem take care guys bye-bye [Music] oh