75. Cracking the Code: Mastering Medical Billing in Alberta | Dawn Osland | Leaders in Healthcare

Are you a doctor feeling crushed by administrative work? What if you're leaving tens of thousands of dollars on the table without even realizing it? This episode were joined by medical billing expert Dawn Osland. She unpacks the chaos inside Alberta's 1,200 page billing manual and introduces her new AI agent, Betty, designed to help you get paid for the work you're already doing. Stay tuned. We need to break the system. We need to implement it. It shouldn't be in a book anymore than a hundred pages. I remember back in the day, I used to be able to bill for a whole entire clinic and it took me probably 10% of the time that it takes me actually now to look after the same size clinic positions tend to underbuild quite a significant decrease in their revenue. If you're looking at about $95,000 lost in here. How concerned about audits should an average physician be? It's quite more common than people think. Have you noticed any discrepancies between like how the PC-PCM model has been advertised to physicians versus the reality? Yes and no. What percent of them regret switching? Maybe about 10%. When the first panel payments came out. There was a lot of doctors that were like, "This is a lot lower than I thought it was supposed to be." Well, how are you doing your diagnostic work? Alright, so finance seems to be the topic of the month here. Don, you've been immersed in Alberta's primary care world for a couple decades now. From your perspective, how has the admit burden evolved from the simple cost of doing business into what many are calling a full-blown crisis? Well, I've seen a lot of changes in our financial system over the last 20 years and in the beginning it was a lot simpler, a schedule of medical benefits. You know, didn't have all the additional layers to it that it does now. So I have seen that there's been quite an increase like you say chaos for the amount of admin work related to that work around, you know, doing their health service code billing, their diagnostic code billing. It now takes a full team. I remember back in the day, I used to be able to bill for a whole entire clinic and it took me probably 10% of the time that it takes me actually now to look after the same size clinic because there's so much more intricate rules and regulations and governing rules that I found. It's really turned it into more of a bigger team administrative sport than it used to be. What was actually different? So they've been updating the rules or the codes or how has that changed over the years to make it more complex? Because I was only born into the medical field a couple of years back and so I kind of just inherited it in its current form. What did it used to be like? Well, you got to think a lot of different codes that have came to, came into play over the last even five, six years, even since COVID. You know, we didn't have virtual visit codes. We didn't have email codes. We didn't have these different, these different codes that were great because they helped with the cost of, you know, of doing business that way. But there are additional layers that need to be learned not only by the physician but by also each of the clinic team, team members that, you know, are helping out with that processing of that email to make sure the physician knows it did go out and they can bill for it. So there's all those additional layers plus with the expansion of modifiers which are great and we need them. But it's also keeps adding layers and layers of complexity, especially when there's rules related around them. There's some billing codes that have some crazy rules. Like for example, you're emailing for a patient. Your zero one or zero 3.01s. It has these crazy rules around it. If you see in the patient the same day or they were seen by another health care provider in your clinic, the week prior, that you can't bill for it. So it's like having to have a secret decoder ring to figure out well, can I actually bill for this? And so it's those layers of complexity I found have made it quite an administrative burden today compared to where it used to be. Okay, so a bit of a double-edged sword. You know, careful what you wish for. We got the fee codes but it definitely has added more to that headache. And of course, just like, you can't go more than 10 minutes without hearing about, you know, burnout in the administrative burden. And so all these little things just wind up adding more and more tasks to the to-do list at the end of the day. Very much so. When you're dealing with somebody who's new to Alberta, whether it's an international medical graduate or somebody who's moving from a different province, what are the biggest things that they're surprised by when they show up and get the full? Here's the introduction to our system. I have to say one of the biggest things and is the size of the schedule medical benefits. The fact that it's 1,234 pages long and honestly reads like stereo instructions from the 80s. That is a little overwhelming for them and that tends to be like, "Oh wow, I have to learn that too." And another hiccup that I've seen, especially with international medical graduates, is ICD-9 codes. They may not have utilized that level of diagnostic codes, where, for example, if they were in the UK, they might have used ICD-10 or they might have used a different form of diagnostic coding. So that is a bit of a hurdle as well because that is a very intricate part that plays into your healthcare coding as well. So that is some of the biggest ones is the amount of knowledge that they have to learn in order just to invoice for their patient visits and it's a little overwhelming for them. I didn't realize the whole schedule of benefits was that long. Holy smokes. Yes, I actually have a printed-off copy. I keep right beside my desk so I never lose touch with the size of that book. That sounds like a good way to fall asleep if you're having a restless night. Yes, it is. And it's a great paperweight or the size of it is even good for keeping the door open. What's the actual difference that ICD-10 codes versus 9? Is it the same type of system? There's just different verbiage. It's almost like learning a new language or is it actually organized differently? I haven't dug too deep into ICD-10s, but what I can tell you about ICD-10s here in Canada is in primary care, we tend to use across our family physician offices, that type of thing. We tend to use ICD-9 codes. But you will see ICD-10 codes in other provinces, specifically more in hospital use. That's where you tend to see a lot more of those codes being used and in the US as well. Gotcha. Okay, so the very similar system is just, yeah, you get into medicine and then you go to learn Latin so that you understand what's going on with the body and all the systems and diseases. And then you go to learn your ICD-9 codes. And then if you're new to the province, you might be having to learn a fourth system on top of that one. Exactly. And then if you move to another province, you're learning a whole new system and that province again. And the fun just keeps going. Yes, it does. And so I guess you could definitely see the fee-for-service model as a big driver of the at-min burden problem. So in your view, from your perspective, what are the specific features of that fee-for-service system that have contributed the most to physician's stress and to uncompensated work in the after hours? I would say the number one thing would be the CMGP modifier, which was introduced in 2009 and has been working in its current format since about 2011-2012. And because the CMGP modifier allows a physician to be able to bill for that pre-imposed appointment administrative work of reviewing the chart, you know, the charting afterwards, the writing referral letters, is a lot of times that gets under calculated when it comes to billing for two Alberta health care. Especially considering those tasks have to take place on the day of the patient's visit that really limits the availability she utilizes modifiers. And I have really seen that physicians tend to under bill for the amount of time in the complexity they're spending with those patients, especially when they're doing the after hours work. Because how many times do we think we sit at our computer and we spend an hour? And then somebody next to us is telling us, "No, you're actually on it for two or three." So we, as human beings, tend to think we're a lot quicker at things than we actually are, and I do see that kind of flowing into that different modifier use within fee-for-service and has had quite a, from what I've seen, quite a significant decrease in their revenue when they're not utilizing it properly. All those chronological optimists wind up shooting themselves in the foot by under billing. Yes. And it's very easily done. Very easily done. A good example is, is a 55-year-old female patient comes in for a follow-up visit. She scheduled for 15 minutes. Well, the physician spends 22 minutes in the exam room with the patient. Then spends another 10 minutes on the pre-imposed work, as well as an additional 10 minutes doing charting, charting, billing, etc. Get said all done on the same day. Now we're looking at 42 minutes of entire time spent pre-imposed and jury. A lot of times the physician will only bill one or two CMGP units for that. Therefore, leaving themselves at a loss from $38 to $58 for that patient visit. Now you do that times 10 patients a day, five days a week. You're looking at about $95,000 loss a year. For work, you're already doing and you're entitled to be paid for. Are you a healthcare professional ready to take the next step in your career? Do you dream of a role where you truly make a difference in a community that's perfect for you and your family? Well, then let me introduce you to Cherry Health. Our platform puts thousands of healthcare opportunities right at your fingertips. Explore jobs by location, specialty, compensation, and more. All on an intuitive map-based platform, available on Android, iOS, or your computer's internet browser. Create your professional profile for free and get started messaging directly with employers. Beyond the app, Cherry Health also offers personalized, white love recruiting services who can guide you every step of the way. Your dream healthcare career is just a click or a phone call away. Visit www.cherry.health to start the next phase of your journey. And so, is it the CMGP modifiers wind up being the biggest volume of cash left on the table when it comes to billing or are there like other things that you flag often as being bigger problems than that? I flag the CMGP modifiers one of the bigger ones, but there is a lot of different things that are getting missed as well. Could be simple things, for example, as you've seen that patient and you also gave them their B12 injection. I see a lot of injections being missed as missed in visits, liquid nitrogen treatments. I see that being missed as well. As it's just those little add-ons, but they forget that you can layer those claims together and that some of these claims do pay together. So, I do see that that is a miss as well as some physicians if you're doing let's say more than one procedure in a visit. A lot of physicians don't know that that secondary procedure usually will pay at 75%. You may not get the full 100%, but 75% is better than 0%. So, that is one area I see a lot of revenue loss as well when they're doing multiple procedures but not actually billing for all of them at the same encounter. Okay, very interesting. And then, certainly, you've been using the new PC-PCM model that's been all the high-play layer. At least we've been hearing about it quite a bit in the physician's fear. Could you give us kind of the quick and dirty overview, the rundown of just how that works now for people who aren't familiar with it? Well, the PC-PCM, it's quite an interesting new model. It's basically, it takes your original scheduled medical benefits, that lovely 1200 page book, and we slap a four-part algorithm on top of it. Now, to break it down nice and simple, it basically breaks down your payments into a portion for your encounter, a portion for your direct patient care time broken down by hours, your indirect patient care time broken down by hours, plus an additional payment for your panel complexity. Because it sounds confusing, you bet it is. But overall, it applies for a physician, let's say, that does longitude no care. A physician that's looking after a panel. You need to have a minimum of 500 patients to qualify for it. And, preferably, working in one location. If you're working in multiple locations, I can get really complicated and a bit headaches some. So, if you have the qualified panel number and you're practicing the longitude no care, if the physicians I have been working with, there's been a mixed group. Some of them have really enjoyed it. We've had a couple that have found it about a similar to what they were billing before. But on the average, we have found that they have found it has been more easy to be able to track what they're doing. In the past physicians, for example, with the CMGP modifier, it was per patient and done that day. I've had a lot of physicians tell me that now that they are able to track their time in the amount of hours they spend in a week. Actually, doing that care and it's not tied to a specific patient, it's given them they said more flexibility. They're not having to really track every single little movement with every single little patient and every piece of paper that's related to that patient's journey for that visit. So, it's really, it's given them more freedom I have found. However, I did ask a few of them because how long, when's the last time you had to track how many hours you're working? I bet you it's been high school, med school, where you've actually, you know, have an hour clock. So, I did ask a few of the physicians if they found that that was a little bit different. And I did have one or two that said it took them a couple of weeks to get into the habit of kind of punching a time clock at home to make sure that they weren't missing those extra hours. A few of them said that their wives were really helpful at making sure they didn't forget. I could imagine. But it definitely, like, coming from the CMGP system, I think most doctors wind up setting up their schedules to just be in line with, like, those 50-minute appointments. Versus now, it seems like it would be a lot less constraining that way. Like, instead of having to try and time things to match with those CMGP modifiers for your standard visit, you're kind of just like, okay, I'm just going to see my patients and then all of the, let's say, the computer work, the forms, the stuff after you can kind of get into a bit more of a rhythm and just do that all at once versus that switching cost of trying to computer work back to the next room for, you know, in-person care, computer work quickly back to the next person. You probably get into a bit more of a flow that way now with the new system. Yes, that is a lot of feedback. One of my physicians in particular, he has said to me, he's never felt so efficient that it has given him a real boost and efficiency on how he's structuring his day and that he wishes that this would have been around a few years ago. Okay, well, it's definitely some good feedback to have God initially here. Maybe there is hope for us. I do think it is a good system, you know, anything has its intricate rules to test out, but overall so far I find it's been, it's been interesting and I'm sure it has brought to light a lot of information that we have been trying to teach clinics and physicians for years in related to billing. And I find now with this new model, it's brought things to the forefront within a month or two. A good example is diagnostic coding. When the first panel payments came out, there was a lot of doctors that were like, "This is a lot lower than I thought it was supposed to be." So, and I worked with a couple of them and I said, "Well, how are you doing your diagnostic coding?" And we pulled some reports and found that 20% of the time, they were using a 780 instead of using the more appropriate diagnostic codes for whatever that visit might be for those patients. And we did find that some of those codes were associated with some of their more complex patients. So, they were able to see within a first couple of months of being on the new pay model what an impact that diagnostic coding was actually having on defining the complexity of their patients. Where in the past, that's something we've tried to teach in the system for a long time and it never really got that uptake where I find now that it's tied to something that we can show right away. We're getting more, we're getting more interest in wanting to be an active part in making sure that those are coded more properly for diagnostics. So, that has been a really interesting feedback from it which I found was, I think, an unattended consequence of the program but I have found has been a major benefit for my clients. Very interesting. Like, just drawn on my own experience there and this is probably somewhat primitive from your perspective. But when I was taught in residency was, you know, the only time the diagnostic code really mattered towards your billing was if you're putting in like a mental health billing code. And in which case, it just had to start with a 300 something something and beyond that, it just never really mattered. And so, that probably on the back end in terms of statistics and just, you know, the health data tracking probably resulted in a lot of like, not great data coming in in the first place. Well, you got to think our HQCA reports that we get that tell you, you know, your percentage of diabetic patients. That's based on diagnostic coding. Same with the CHI high grouper. They based all that on diagnostic coding. So, a lot of our healthcare data all across coast coast here in Canada and provincially is based on that diagnostic coding but we don't really, we don't teach the importance of it. In medical school, in nursing school, we really, really, we don't highlight it as much as we probably should have. Interesting, interesting. I'm starting to think now that this the shift to the PC PCM model is probably adding to that complexity and arguably that it minburden in the first place because you still got to know you get your fractional payment for the fee for service stuff. So, you still need to have your 1300 page manual memorized and then on top of it, now you got to get a little more into the weeds when it comes to the diagnostic codes and the timing. You're making a really good case for why billing is probably a good idea. Yes, I do find that billing support is good and if I'm being completely honest, I think we're coming to that point in our healthcare billing system here in Alberta where we need to break the system. We need to simplify it. It shouldn't be and it shouldn't be in a book any more than a hundred pages. 1234 pages is outrageous and you know, we've innovated so much in our system over the last 20 years but yet we're still using that same old crazy book. It's time we make it easier for all the physicians in the province. Very cool. Well, it's good to see things getting updated, you know, whether it's bit by bit or drastically. It's kind of funny to think about this but when we first started with the whole Cherry Health business, this would have been like probably five years ago. We acquired a couple different mentors as part of the venture monitoring service program through the University of Alberta there and one of the mentors that we acquired, he had been working on the original like the back end computer system for the physician billing for Alberta health services and that was I think like in the 80s or 90s and he said they're still using that same core technology. This would have been 2020 2021 when we were we're talking with him, but it's kind of funny just to think about, you know, like how archaic some of the software, some of the programs that are still powering the whole province are. Yes, exactly like they are very outdated. Hopefully, you know, with all these advances in technology over the next, you know, few years we see that change. So tell me a little bit more in terms of the PC PCM model, who is the ideal demographic for making the switcher who's going to benefit the most from switching over. Now, physicians that are practicing longitude no care. That is really that wants to dedicate to their practice to looking after a panel of patients. That is who it's most suited for. Now, if you're a physician, only works two, three days a week and diversifies your time, let's say between long term care and other other aspects in the health care field, which a lot of physicians do. It may not be the most, may not be the most best program for you to go on. I do find that for your physicians that are working five days a week that it that you are putting in that amount of time. That it really is a good opportunity for them to look at it. Now, with that being said, I have had some physicians that are full time physicians that are such amazing builders. That they they have stayed on fee for service only for the sake of that their brains will work work a little like a computer. They're a very small group. So they they're billing. They didn't see quite an increase when they didn't an assessment related to it. But for anybody practicing longitude no care, especially if you're working four or five days a week and you're putting in long hours and if you have a large panel. That is another thing as well. A very a bigger panel. I find that it gives you the availability to be able to look at that to look after them that little bit more without feeling like you're constrained to only the patients you've seen that day. So I do find that it is that would be who I would recommend is more your longitudinal family physicians. Okay, so those doctors like bread and butter classic family medicine. That is sort of the ideal demographic. Yes, for that ideal traditional old school type of family medicine. Yes, that's what I would recommend who it's for. And then there's the minimum threshold like the 500 patient panel just to qualify for that in the first place. Are you finding that for those doctors that are let's say they're doing diversified, you know, something different throughout their week. And maybe they're doing three days a week of family medicine, you know, that classic clinic. Maybe they've got six, seven hundred patients or maybe they're just barely hitting that minimum cut off is there like a threshold that you found in doctors switching over where it still does wind up being beneficial. Or is it like if you qualify switch over or the opposite like some people qualify and it winds up actually being a negative to their billing unless they're I don't know a thousand 2000 patients on their panel. See, I've seen a little bit of mixed reviews. I've seen some physicians that only have a five 600 person panel that are doing quite doing quite well on it because they choose they have small families at home. So they don't want to they want to make sure they're getting into those those 500 patients 600 patients are getting into see them quite regularly. What I have been recommending to a lot of physicians is to look at what the return visit rate is. How many times are your patients on average returning over the course of a year because that'll really help to see, you know, how fast you can get them in now. So the one drawback with this PC PCM is the bigger your panel, the bigger the panel payments. Now that can be dangerous because at the end of the day, even if a physician is working five days a week, even 10 hours a day, you can't look after 5000 patients a year. It's just it's not possible. It's, you know, the supply and demand. It's just not there. So that says something is to really take a look at where kind of your panel threshold is. How often are they coming back in to see you? What is your capability that you have available for doctors who are looking to start out and are just kind of shooting at the 500 panel mark. I do recommend to them and I have to some of my clients to go first go to 600 because you do have if you fall below that 500, you have a 12, you have 12 weeks to get it back up before, you know, you might you might come off the program. So if you have 500 just 500 patients and two families move away, all of a sudden you're under the threshold. So I do recommend to any physicians that want to transfer over hit that 600 mark. Yes, you qualify 500, but if you're going to cap your panel 500, maybe do it at 6 or 550, so you have that bit of a buffer. So you're not worried if a couple of families move away or transfer that all of a sudden you have fallen under that threshold because you only have 12 weeks to get back up over it before they would actually take you off the program. Gotcha. Okay, that makes a lot of sense. What about patients who they cheat on you? Maybe it's your fault because you didn't have accessibility and they couldn't get in for their acute problem. Maybe it's not. They were just fickle and felt like going to a different clinic or walk in. How is that actually handled in terms of the penalty when it comes to this is my patient on my panel? That's a great question. Right now for the first 12 months sold that from April 1st of this year until the end of March at next year, there'll be no penalty if a patient happens to show up in more than one doctor's panel. But and this is the but as of April 1st of 2026, that will not be the case. If a patient is showing up on doctor X's panel and doctor Y's panel, nobody gets the panel payments. And then those two physicians, we're setting up our clinic managers are Emma ways and our doctors unfortunately to start fighting over patients. Well, this is my patient. No, this is my patient. Okay, it's going to be a mess. It's going to be a mess. Come April 1st. So it's really important that every clinic is looking at their kind of panel management systems now instead of waiting until right until the end when it's starting to. So you're not having that back and forth. And we're already seeing it in some clinics already where it is happening where clinic managers are fighting over patients know this patient's been coming to CS for three years. Well, no, they've been here for five years and there's we all know there's a lot of patients. There's what 750,000, 800,000 unattached in the province. There's a lot of patients to go around that need a family physician. But that is one of the biggest drawbacks that I do see with this PC PCM is I do not think that we are going to be prepared for what's going to happen. Come April 2026 when all the sudden panel payments are going to significantly start to drop for some physicians and they're going to be put in a put in a position where they're going to have to start taking a more active administrative role on figuring out why it's that way and probably engaging with some of their colleagues about these patients. I do think it's going to be a bit of a bit of a headache for them come next spring. Have you come across any guidelines or advice in terms of counting a patient towards your panel like let's say the patient has come to the clinic walk in clinic and you've seen them quite regularly throughout the year like you're not their family doctor but their patients calling you their family doctor. I've had this happen numerous different occasions you start getting CCed on different results or like is there any kind of guideline as to how to handle that so there isn't any kind of infighting. Well a lot of the in the province here we've had a lot of different initiatives that we passed over the last few years in regards to like panel management. The different PCNs and their quality coordinators have worked really hard with a lot of the different clinic teams to teach them about being able to have those conversations with the patients as well about identifying who their family doctor is. But it also goes a step further a lot of it has to do with your internal workflow processes in your clinic as well do your staff understand when a brand new patient that let's say hasn't been there before is coming in and you're creating their chart in the EMR. Do they understand what the word primary provider means what an active patient means. Do they understand all those different mechanisms when they're putting when they're putting in that chart because I am seeing a lot of workflows there where patients are you know they came in to see a local physician is listed as their primary provider and then they're running into this if it gets uploaded into CPAR and see and all of that where they're running into all the sudden it's just from an administrative error. A patient's got put on another doctor's panel so there is quite a bit of that so being able to identify your workflows within your clinic to be able to figure out how you're identifying your panels how you are communicating with those other other clinics as well. As well as internally I've also seen some crazy I don't want to use the word infighting but conflicts within a same clinic where there will be doctors some doctors are on the PC PCM some are on their fee for service some come in and do some specialty days here and there and then they also have a group of local physicians to come in there's been a lack of a lot of conflict between some physicians in regards to offloading for example if the doctors on the PC PCM the patients are supposed to be in to see them. But sometimes a clinic flow process has gone sideways they'll put them in with the local instead. Then all of a sudden all these physicians these patients are getting booked in for a follow up with not their family doctor and this doctor on the PC PCM now is kind of violating this offloading rule without them even knowing that is actually happened in the clinic. So it really does come down to a team base for between your physicians your clinic management and your teams making sure that your reception medical office assistance are all kind of working on it together. Okay so there would be like a little bit of growing pains here for many of the clinics but overall step in the right direction. Yes. Attracting top healthcare talent is crucial for providing exceptional patient care but connecting with the right professionals can be time consuming and complex. Cherry health bridges the gap. Our network allows you to showcase your organization post jobs with precision and ease and directly engage with healthcare providers actively searching for roles like yours. 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Yes and no I find the boots on the ground reality is they are they didn't realize how much extra work would go into it. That has been on how much extra maneuvering in your EMR would be needed how much extra set up I did find with a few of my clients we did some of what I would call day in the life real assessments. The AMA calculator for you know the suggested calculator for looking at to see if it's a good program for you as a family physician. They didn't find as useful the found it was an okay tool but it gave you a possible in the future this is what it would look like where a few of my clients were like I want to look at the real hard data. So what we did is we took a week of their previous bills that already been paid through Alberta health care patient encounters and we transitioned it we took off all the modify amounts to it we put everything back down to the GP base rate. We reduced it to the 68.5% we removed anything that would have been out of basket or not qualified so we and then we looked at that calculation of what it would have been for their fee for service. We did a rough estimate of how many hours they would have worked throughout that week you know going by like what the standard research shows. And then we the only thing we didn't put into it was accumulation of the panel payment because that again we didn't quite know where that would sit at until it you know the first one started coming out. And we found that that gave a more of a kind of real life estimate that was a little more accurate to what they're actually seeing that they're getting now. Then where we found with using the AMA one it did give us a little bit more of an over estimate that wasn't that wasn't actually reflecting right back to what they were actually billing in their clinic that day. And some of the input lines we weren't we weren't able to adjust them to kind of reflect the specifics of a certain doctors practice. They were more generic so we did more that day in your life to get a real hard look at that because they wanted to see the hard data of something that it already happened not the idea of what could happen in the future. How close did they match up like was it reasonably accurate or was it quite far off in some of those cases. A few I'd say anywhere from two to five thousand dollars in difference. So not a great deal. Not a great deal when you're doing an estimation because even when we were doing the live data it was an estimation. But they were about anywhere from a two to five thousand dollars off for the course of what they thought they'd make over the span of a year. So but some of my docs are very much about they like the hard fast real numbers. So got so I thought you meant for that one week I was like holy smokes no margin of error no. And then of course all the yes close yes and then all the estimates that we did I have a day in the life didn't include the panel payment which was also kind of a bonus too because a lot of the docs when they looked at their assessment were like oh I like that. And then I then it was nice to be able to say to them yes and then you get your panel payment too. So then they're like oh wow. So it was quite interesting that way for them. Okay, okay. And then of all the doctors all the clinics that fit that sort of ideal persona they're doing that you know 100% full time classical longitudinal care. What percent of them regret switching who have switched from the ones I've spoken with I'd say probably maybe about 10%. But but a caveat with that I find is because they haven't fully fully dug into all aspects of it or they might be in a situation where they're not having that clinical support that they need in order to make it you know effectively put into place. There's so many factors that kind of play into that that it's not just you know the physician it's about everything and everybody they have around them as well. Okay, so there's still some hope that they'll be able to like make it work on the new model and benefit from it's still one in 10 that sounds like not a bad hit rate still. When it comes to the doctors who are having a mixed week let's say is more commonly going to happen in rural care where a majority of their week they're doing that longitudinal family practice in their clinic. And then they're also doing you know hospital rounds in the morning and then potentially some emergency shifts like what are the pitfalls for a physician who's going to have to be using both systems you have the PC PCM and the fee for service in a single day. Well, one of the pitfalls in that situation like you described would be that they're going to have to be jumping back and forth between their two BA numbers which could be could very easily get confused and built under the wrong one very easily. After the PC PCM any of your long term care or any of your hospital stuff would have to fully be just done under your fee for service billing where as in your clinical would be under your PC PCM. I do have a couple of clients that actually do a little bit of hospital billings and in the first month that did happen they were they actually switched them and were billing under the opposite. So the EMRs I have to say have gotten a lot better since the announcement of the PC PCM with letting us toggle back and forth between the two BA's which I know a lot of the doctors have been happy about and they are always making advancements to the PC PCM. So for example in the beginning you couldn't bill an out of province health care patient under the PC PCM it had to be billed under your fee for service BA within the first couple of months that corrected that so that way you would still be able to so that way mid clinic. You're not jumping in between BAs or schedules because could you imagine what a mess that would be having two schedules that would be just insane so they are slowly starting to figure out ways to be able to bill it under your PC PCM and making the proper adjustments. Okay, right on that makes a lot of sense. You're having to like manage multiple all at once that would be a tall order. That would be a nightmare plus because you think of a clinic admin if all of a sudden now you're dealing with two BA's two schedules for a doctor and you've got 10 doctors in a clinic that would get you that would be an administrative nightmare. I guess then do you have any other tips and tricks when it comes to the PC PCM model for doctors who let's say they have already switched over now they're trying to maximize their billing optimize the numbers. What should they be looking at? Well, when it comes to the PC PCM is make sure that you are max packing your billing. So for example if you're doing multiple procedures out of visit make sure you're putting them all on there so that way you're layering each and every single one of your claims for example your patient came in for a physical plus they also got liquid nitrogen and their B12 make sure all of those are on your bill. Some of them may pay at 75% but still it's better to have them on another thing is making sure that you're tracking your time that is so paramount. It's very easy for us to jump into our EMRs and okay I was in clinic for eight and a half hours yesterday but same with the CMGP modifier which was indirect patient care tracking your indirect patient care and nights and weekends at home is something that's paramount because every hour is worth money now. So missing 25 minutes missing half an hour missing an hour missing two hours this adds up so it's very important to make sure that you are not under selling yourself and that you are tracking all those minutes and hours that you're doing stuff even if it's a half an hour in the morning as you're drinking your coffee and you're checking your labs on the iPad that is still billable time so it's getting into that behavior of making sure that when you're doing those items you're remembering hey I need to track for this because I get paid for this. What is the qualification criteria for billable time like is there any sort of things that don't count towards that? Yes, good example would be your driver's medical that's a service that our patients coming in and paying for so that wouldn't be something that you would bill under the PCPCM plus you would also you would not bill your time for doing that as well. Another one would be your insurance forms so any forms that are covered under your insured services for example that would be covered under upper to health care. Yes, that time to complete those would be filled out, but you know all those dreaded insurance forms that you doctors get that are a third party billing the time to complete those would not be considered billable time under the PCPCM for your indirect care. So that is one and that's a bit of a drawback I find and you know some of that paperwork it's I hate to say it does take quite a while. And when it comes to the time tracking you've recently come up with the track my time app I understand or how has the rollout there been going? It's actually went really well now with the track my time app what it does is it gives the family physicians the ability to be able to track their director indirect time be able to log it on the day that they do it and it even goes as far as breaking it down into the number of units because in order to build for the time you have to break it into 15 minute units. It worked 10 hours it'll actually tell you how many units so easy for transposing over it also has an audit ready feature in it which I really love because we all know that audits come and with being a new system a year or two down the road I guarantee those are probably start rolled out across the province. So I thought right away how can we make sure that you have everything you need when it comes to tracking especially that indirect patient care time this maybe not in the EMR because you were reviewing articles you were reviewing different things related to a specific treatment for a patient. So the track my time would give the physician the ability right on their phone in an app to be able to log their time for that night then it gives them a complete record of it that they are able to access right from the app or even share because we know that some clinics have billing agents or their MLA's help with it they can share this non patient identifying entry right specifically from their phone to a staff member who then can enter it for them in the EMR. And as an added bonus because we want to make sure they're protected when it comes to audit readiness is every month we send them out an audit readiness package which gives them a complete spreadsheet including M their IP stamps of when their entries were listed a complete copy of each of their entries as well as a nice beautiful graph that shows them how their time broke down. Because one of the caveats with the PC PCM is a position is not allowed to break the 20% related to direct patient care that they give after hours in comparison to the regular business hours. So each month we give them a cumulative grant or a graph showing them where they're at if they are getting close to that 20% threshold that would activate a claw back from Alberta health within the fiscal year. Okay cool cool. How concerned about audits should an average physician be I can't imagine. I don't know from your perspective like how common have audits been done on your previous clients. Like it's not something that I've really heard much about other than the ones that make it into the newspaper for grotesquely over billing. It's quite more common than people think believe it or not auditing I find happens quite often with different clients that I have or I'm brought into help with different clients that are coming under an audit and it can happen for a lot of different reasons. So it's very important to make sure at the end of the day that you was an individual physician because most physicians are professional corporation you know that are working within a clinic. But at the end of the day the buck stops with that doctor not that clinic not that billing agent not that MOA. So when Alberta health or Alberta well health and wellness comes into audit a billing thing they're coming straight to the physician. So it is paramount that you're able to back up that last year those hundred hours of direct time that you built and you weren't in clinic that week where did it go. Now I can tell you from my experience I have done some audits of clinics in the past is auditors do not like if you have them a box of Post-it notes or a booklet you've scribbled in because you could have made that last week. So having a digital record at the end of the day we all know that's that's king when it comes to being able to show to show what's that you're ready for those audits. So with the track my time app you get this package once month so if you're audited down the road you simply just share these packages directly with them and there's all your proof that you entered those entries at that date and time that you said you did. Okay right on so making it a little more seamless easier fool proof if you do get audited you're not scrambling and trying to put out the fire. Exactly because nobody likes an audit. Tell me more about how the CMGP calculator program can help anyone with missed revenue who's planning on staying with the fee for service system. What are you offering there? Well with the CMGP calculator if you're still on the fee for service system it is also available as an app as well on your phone or on your laptop or your computer right in your clinic whichever you prefer. It is non-patient identifying I mean it gives you ability to enter in the amount of time you spent in the visit and all the extra little bits you did and it gives you a total of CMGP units that you would qualify for for billing trouble to healthcare. Now our beta testing last fall that we did with physician showed that they were on average leaving about 30% unbuilt. That unless it was a patient you know if you've seen 20 patients that day what sticks out in your head is that one patient that was you know you were a little bit longer with the one that there was an excessive amount of paperwork. There's maybe those two or three that really stand out but what about those other 10 that had all that extra work that you did too but didn't really stand out in the day. Well as you're completing your billing you're under billing for that so the CMGP calculator not only helps you to catch that but also helps to in a way kind of retrain the way you're looking at your billing. So that way when you are doing these things and you're completing the billing at the end of your day you're looking back and remembering those tasks that you completed related to that patient visit that you can now incorporate in. As an added bonus our CMGP calculator and our track my time they are completely free so there's absolutely no fee for any physician to be able to use it across the province of Alberta. That's our gift to the primary care. It was very generous of you thank you. How does you go about coming up with the program in the first place like what kind of feedback were you hearing that this was necessary in the medical community. Like I just I can't believe that people are missing up to 30% of their billable time as wild. Actually how I came up with that is one of the physicians in Fort McMurray that I worked with for over a decade. He trained me from the beginning when you see a problem you don't cut you come to me with three solutions. And I kept going to him and saying we needed extra staff we need extra staff and he kept saying okay how are we going to pay for that extra staff. And I kept finding the billing holes and I had seen that he was under billing with the CMGP modifier. So that's kind of where the idea kind of formulated from was seeing these physicians and clinics over and over and over again under bill. But then when they needed resources that weren't able to be compensated for by being able to prove to these physicians well if you do A, B and C we can get that staff member. That's kind of where the tools formated out it was being able to see working with that physician in Fort McMurray how he was missing things. And then realizing I wanted to be able to give this to every doctor in the province. So that's one two years ago I started sketching out the CMGP calculator on a piece of paper and then finally birthed into the tool it is today. And is this like a freestanding standalone program or do you need to integrate it with your EMR? It is a freestanding program because we didn't want to wait we all know privacy legislation is a lot getting a patient identifying interactions with an EMR exactly I be looking at three to five years of red tape. I didn't want to wait three to five years to be able to help you today. So we made our tool non patient identifying and it is a companion app off the side either on your phone or off the side of your computer. But we are looking in the future to have it integrated into the EMRS because a lot of feedback we have received from physicians is they would like it right in their actual bill very cool. And then what about when it comes to rejections and bills that have been denied what's your suggestion for physicians managing that side of things. Well for physicians managing that side of things I'm really happy to announce that we actually have a new healthcare billing intelligence coming out calling Betty. She is going to be launching in August and she specifically helps family physicians deal with their rejection codes. You can simply ask her what a rejection code means and she will tell you what the code means and she'll even tell you how to fix it. So Betty knows all 1300 pages of the schedule of medical benefits very very well I'm guessing pretty well yes. Very cool and so how do you actually interface with that it's like a AI like if you talk to chat GPT and Internet Explorer tab on your browser is same thing. It's just now we've cloned dawns brand and then integrated it at the same level there. Yes she's going to be available on your you be able to think of sorry for healthcare right on your phone you'll be able to talk to her so you won't even need to you can have it on your computer your iPad or even your Apple watch where you could simply ask for a simple question on your Apple watch. If you want to know what the diagnostic code was or what one of the rejection codes was because she will also be able to answer questions in relation to all the ICD-9 diagnostic codes in common language. Now when I say common language when I first started out doing medical billing I didn't have a very big medical terminology database. Now ICD-9 are diagnostic codes that's the way they're set up if you don't have a medical background it's difficult to find the right code. Well Betty is so simplified that if you say cut on foot instead of laceration she's going to tell you exactly what you're looking for. So you're able to talk to her even as if it was a grade five person asking a question or a very highly educated physician which is really important when it comes to team based care because we all have different ways that we address things or for example even international medical graduates. But we call an exam room here in Canada in the United Kingdom they call a theater. So even those changes of how we call different things. So we wanted Betty to be able to be accessible for everybody no matter no matter what your education level was related to your health care knowledge. Very cool. Are there any privacy security implications with using such a tool or is everything sort of conducted on that there's no identifying patient information in their level so you don't have to worry about it too much. Betty is non-patient identifying and we do recommend to our users when we're onboarding them that and remind them that you're not to be speaking to her in a way where you're saying you know Janet Smith was in for her injection this afternoon you know with her husband Roy. We don't want them speaking in that way we would rather them speak a more generic tones in relation to in relation to using her at least at this at this point in the future that may change but for right now she is to be non-patient identifying and you were talked to her more in a generic way you were talked to another colleague without saying a patient's name. It's interesting to see like the back end of AI tools happening because so far I've just been privy to a lot of different solutions on the front side namely the AI scribes really just blasting off into the medical sphere so it's kind of cool to see that the actual like administrative end is getting a technological upgrade here too. Yes, it's very important because health care is a team based event and we have put out a lot of different AI tools and a lot of different opportunities for physicians for the nurse practitioners for the RNC LPNs but we tend to forget about the the admin in the back the you know the hubs of the clinic that actually keep everything rolling and we really need to start bringing them the tools to make them more efficient especially tools because AI everybody fear. That you know it's going to take my job so I know it also medical billing tools I one of our main goals is to make tools that work with you not for you and don't ever take your job over for you it's meant to be a partnership of AI and the integration of the workflow at the same time. Where do you foresee that partnership going for its future direction as things continue to develop and it becomes more sophisticated. Before I honestly see it going is right now we have a lot of what I call one-sided communication tools and we want to integrate all these AI components into our health care teams but what's a team member a team member is not somebody that just listens to you but somebody you can talk to and you can interact with. So I do see these tools formating into their own I don't want to say personalities but their own type of workflow person and teammate because it be easier to integrate all of them as a team member. And less fear if it's a team member coming to help me do my job opposed to a team member coming to take over my job. So I kind of see that evolution of that kind of AI persona let's say you know Jarvis for health care let's say. Well I look forward to seeing it play out over the years definitely an exciting time to be in the medical space. Yes it is. I guess any final advice any last tips you'd give to the physicians the clinic managers out there about how to better their practices. Take a look at everything that you're doing in relation to clinic workflows number one is always make sure that your clinic workflows are aligning with the support that you're giving your physicians in relation to health care building. And judge where your physicians are at meet them where they're at judge what they're where their level is at with their upper to health care building and help them to increase that knowledge by helping them learn how to do little bits at a time a little bit better. Because then as the clinic grows and as the team grows you're able to work together for it because filling really is a team sport. It isn't a solo thing that is done just by the physician anymore. So it's really about being able to listen to each other and hearing what that doctor needs. That is so important and learning what their little hiccups are when it comes to billing and then being there to kind of help them before they realize they need that. And then I guess if anybody's realized they've got more hiccups than they want to deal with themselves, how can they get a hold of you? What's the best place to find you? Well, they can reach out by phone or they can reach out directly by email to [email protected] and I will get directly back to them. Awesome. Well done. Thank you so much for sharing some of your insights and wisdom with us today. I really appreciate you taking the time. It's been fun. Well, thank you very much for having me. It's been a joy to be here. Thank you very much.