Ontario - Setting up E40... HSCodes for Billing

Date of Tech Note: 25 July 1999
Enhancement:
Bug Fix: N/A

Description

There have been several questions about how to setup the E codes in MediFile. This document describes how to set up these codes in MediFile. Though OHIP indicates that these are just simple HSCodes, they must be sent to OHIP as the next code after the HSC that they ‘modify’. To ensure that these codes go in right after the code they modify, MediFile handles these as ‘modifies’ in MediFile.

Detail

There are two places you need to set these up. Actually only one, but the other area is an information area.

Setting up the Information Area

File Menu --> Administration --> Fee Modifiers

In this area use the normal method to create a new record.

You donot need to fill in all the information. Only the areas shown here.

Setting up the Calculation Record

You must set this record up for the E code Modifiers to work.

File Menu --> Administration --> Fee/Mod Price

Once in this file use the normal method to create a new record. As with the Fee Modifiers record, you do not need to fill in all the information. Fill in the record as the example shown. You must fill in the fields with an arrow to them.

There are two fields that may not be obvious as to what they need to be filled with.

• Amount - This is the number MediFile will use in the calculation. In this example the Fee Modifier intent is to multiple the base amount by 1.5 to provide for a 50% increase in payment. Therefore enter 1.5 in the Amount field. MediFile formats this as $1.50 as this field is used where modifiers are calculated using a base $ amount.

• Action - In this case the modifier needs to multiple the base amount by the number in the amount field. Therefore we use an ‘*’ (asterix) to tell MediFile to do this.

How to Use in Multi-Billing

This is all brought together in the Multi-Billing area. An example is shown here:



Enter the HSCode as usual. Since this is a surgical code, you need to ensure that ‘Surgical’ is in the area right beside the code. If it is not enter it. This will update MediFile for that code from now on.

In the ‘#’ field enter the number of time units for the surgery. In the case shown we entered 10. MediFile calculates the fee total based on the time units.

Now enter the modifier code, in this case E401B in the Modifier area. MediFile brings in the $1.50 into the amount area. It then calculates based on the information entered into the FeeModifier record. In this case it takes the amount calculated ($95.70) and multiplies by 1.5 to get $143.55.

You can now bill the entry. MediFile will then send both the S278B code and the E401B code to OHIP. The E401B code will be sent as Item #2 for the S278B code. Therefore OHIP will understand that they belong together.