⚠️ Important: If you work in Ontario, you must have a MDBilling account set up to bill in the CHR. See Integrating your CHR account with MDBilling.
If you are a provider, the standard and most efficient way to create bills is from within an encounter that is associated to an appointment.
To make your workflow even more efficient, you can add billing items to encounter templates if you use the same billing codes for routine visits and/or presenting issues. See Adding billing items to encounter templates.
Steps
1. Start an encounter associated to an appointment. See Other appointment actions.
2. If applicable, select an encounter template (with or without billing items added). See Starting an encounter.
3. In the Billing Items section of the encounter, complete or change the Insured Payment Detail and Ontario Health Insurance Plan Payment Detail fields, as necessary. For more information, see Creating provincial bills.
📌 Note: In the Template field, ensure Ontario Health Insurance Plan is selected for OHIP bills.
4. To add a billing item (service code) to the bill, click +Insured Billing.
📌 Note: If you selected a template with insured billing items added, the billing items are displayed. Click a billing item to modify or delete it.
💡 Tip: You can copy past insured billing items by clicking the clock icon next to Insured Billing. For more information, refer to Duplicating a fee item on a bill.
A New Ontario Billing Item window appears.
💡 Tips:
When searching for the diagnosis code, only the first 20 matches show. Exact matches show first, followed by favourites, followed by the remaining matches sorted by usage.
When searching for diagnosis by code, if the diagnosis code doesn’t exist in your default diagnosis template (Settings > Encounter > Default Diagnosis Template), any matching MDBilling diagnosis codes and descriptions are listed.
When searching for diagnosis by code, if the diagnosis code exists in both your default diagnosis template and the MDBilling diagnosis list, only matches from your default diagnosis template appear in the list.
5. Complete the applicable fields:
Field | Description |
Code / Description |
💡 Tip: Select the star icon next to the specific code to save the code to your favourites. Every time you create a bill, the starred favourites appear first in the list. |
Base Amount
| The fee amount of the code you selected is automatically populated. 📌 Note: The amount can be manually changed if applicable. |
Quantity | If the code requires time units or number of services, such as codes for surgery, type the number of units or click the up or down arrow. |
Diagnosis Codes | If you added a diagnosis code in the Assessment section of the encounter, it is pre-populated for you.
Otherwise, enter the diagnosis code, or start typing a description to search for and select a diagnosis code from the list.
💡 Tip: Select the star icon next to the specific diagnostic code to save it to your favourites. Every time you create a bill, the starred favourites appear first in the list.
📌 Note:
|
Service Date
| If you are logged in as a billing provider and the patient had a recent (past) appointment booked in your schedule, the date defaults to the appointment date.
If you are not a billing provider, the date defaults to the Visit Date specified at the top of the encounter.
To change the date for the specific billing item, click the calendar icon. |
Time Spent (Minutes) | Enter the time spent with the patient in minutes. 📌 Note: This automatically updates the Finish Time. This field is not sent to MDBilling, only the entered Start and Finish time. |
Start Time and Finish Time | If you started the bill from an encounter associated to an appointment or from the Visits dashboard, the Start Time matches the appointment time.
If you started the bill from the Insured Billing area of the patient's chart, the Start Time defaults to the date you created the bill.
To add the time you finished seeing the patient, click the clock icon. This is important when using B (surgical assist) and C (anesthesia) billing codes for services delivered at the clinic.
📌 Note: When you create a bill and add a Start and Finish time, the quantity is automatically set as 1. If you change the Quantity field to anything more than 1, any entered Finish time is cleared by the system. |
Override Rules | Select to override the diagnosis required rule, and any rules for the specific MDBilling fee code you are billing. For example, if you are billing an anaesthetist code that doesn’t require a diagnosis, you can submit the bill without a diagnosis for this fee code.
📌 Note: Hovering over the checkbox displays a warning message that the claim may get rejected. |
6. To save your changes, click outside the Edit Billing Item window when you are finished adding the service code.
7. To add additional service codes, click + Insured Billing.
8. To edit a billing item, click it and make the required changes.
9. To delete a billing item, click it and click the trash can icon in the top-right corner.
10. Sign your encounter.
If your default billing status is Ready to Submit and there are no errors with the bill, the claim is submitted to MDBilling and the claim status updates to Submitted.
If there is any missing information in your bill (such as a diagnosis or a billing practitioner), or the patient's health card number is invalid, and your default billing status is:
Draft - an error appears and the encounter is not signed. Fix the issue and attempt to sign the encounter again.
Ready to Submit - the encounter is signed but the bill is not submitted to MDBilling. The status of the claim is Attention Required and the individual bill items have a status of Invalid. Fix the issue. Once there are no errors, change the claim status back to Ready to Submit so the claim can be submitted to MDBilling.
📌 Note: The billing items do not appear in the patient chart's Insured Billing section or the CHR Billing dashboard until you sign the encounter.
Updated October 21, 2024