Billing for uninsured services
could add as much as $20,000 extra to your income every
year, but the vast majority of Canadian physicians still
aren't doing it.
Now, with doctors busier than ever
and patients more demanding than ever, we may have reached
a tipping point. The budding industry of private firms
offering to help you get paid for the time you spend
on annoying uninsured tasks is rapidly becoming a booming
one. Professional medical organizations like the OMA
and the CMA are broadcasting their support. Consultants
are crisscrossing the country giving seminars and workshops.
The future is here, experts say — it's time you
stopped working for free.
HOW
IT WORKS
As you well know, plenty of things you do aren't covered
by your province's public health insurance plan: filling
out sick notes and employers' or fitness club physical
exam forms, renewing a prescription by phone or by fax,
giving advice to a patient by phone, and more. But many
physicians are reluctant to ask patients to pay them
for those kinds of things. "Some physicians find this
extremely uncomfortable," says Dr Benjamin Burko, a
Montreal pediatrician and practice management consultant.
But if the government isn't prepared to pay you for
your work, it's only reasonable to ask patients to do
so, he says. "The first thing I teach, and the first
realization you have to come to, is that your time is
worth something."
After you've wrestled with your
altruistic, philanthropic impulse and realized that
Dr Burko is right, it's time to get to work on your
billing system.
DOCTOR
DIY
Some doctors choose to design their own uninsured services
billing programs. But how much, exactly, is your time
worth? Answers vary — there are no rules on how
much you can charge for providing uninsured services,
but there are guidelines available to help you figure
out some baseline prices. The OMA published a comprehensive
and thorough list of suggested prices and guidelines
in January.
You must allow patients to pay
for each service individually, but you may also give
them the option to pay a 'block fee.' A block fee is,
in essence, an insurance plan for uninsured services.
If they join your block fee plan — for a price
from, say, $115, like Dr Burko charges, up to $300,
as one of his colleagues does — then any uninsured
services patients need are covered for a year. Again,
as with the per-use method of billing, the price of
your block fee plan is up to you.
Some patients may balk but work
is work, says Dr Alan Brookstone, a Vancouver FP who
started his own uninsured services billing program in
1996. Did he get a lot of complaints? "No," he says.
"Many expected to pay and stated they were surprised
that I had not been charging for uninsured services
prior to the introduction of the plan and policies."
A small minority was less forgiving. "Less than 1% of
patients were unhappy with the program. Some of those
left the practice." Dr Brookstone's policy was successful.
Thirty percent of his patients chose the block fee option
and his annual billing for uninsured services amounted
to around $30,000, for what he estimates to be about
300 hours per year.
Dr Burko offers consulting for
physicians or groups of physicians who want to implement
their own billing programs, as does the CMA's private
arm called Practice Solutions. It's worth getting some
outside help if you're at all unsure about how to work
out the legalities and the technicalities of your billing
program. Last November, Dr Thomas J Barnard of Leamington,
ON, had his licence suspended two months and was fined
$2,500 by the College of Physicians and Surgeons of
Ontario for block fee plan violations (among other things,
his office assistant threatened patients they'd be kicked
out of the practice if they didn't pay).
OUTSOURCING
Most physicians choose not to try to create their own
uninsured services billing programs, opting instead
to outsource the task to an established private billing
firm.
"If you're a procrastinator or
can't manage office projects, don't try doing it on
your own," advises Dr Burko. "It's easier to have a
meeting or two with the agencies, and then they just
need your patient list and the money will start flowing
in."
For a run-down of the four largest
billing companies in the country, see this pdf "How
do the uninsured services billing firms stack up?".
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