How to Bill H010A Anaesthesia Stipend in HYPEMedical | OHIP

HYPEMedical: How to Successfully Bill the H010A Anaesthesia Stipend

Quick Answer

Setup: To bill H010A in HYPEMedical, create an additional physician profile containing the applicable anaesthesia stipend group number, facility number, and the Force Submit Under Provider setting.
Daily Billing task: Calculate the physician's eligible stipend hours for each service date, create the H010A claim using the stipend physician profile, and enter the applicable stipend tier as the # of Servs.
OHIP Submission: HYPEMedical (version 3 [HM53, HM43 or HM33]) automatically submits the H010A stipend claim through MCEDT along with your normal claims while ensuring that the stipend physician is submitted under the provider as required.

What is H010A?

H010A is not a regular patient-specific fee-for-service code.
H010A is the OHIP service code used to claim Ontario's daily anaesthesia stipend.
For H010A, the Number of Services represents the physician's eligible stipend hours/tier for a particular service date, subject to the Ministry of Health's anaesthesia stipend rules.
Eligible time is generally accumulated during scheduled weekday hours:
Monday to Friday, 7:00 a.m. to 5:00 p.m.
The Ministry's anaesthesia stipend rules determine which activities and periods of time may or may not be included when calculating the physician's eligible stipend hours for each service date.
Refer to:
  • OHIP INFOBulletin 260311 – Physician Services Agreement – Targeted Funding, Anaesthesia Stipend for eligibility and qualifying-time rules.
  • OHIP INFOBulletin 260802 – Physician Services Agreement – Update on Anaesthesia Stipend for the H010A service code and claims-submission requirements.

Four Important Requirements for HYPEMedical Users

Before billing H010A, keep these three requirements in mind:
1. H010A must be billed using a physician profile affiliated with the applicable anaesthesia stipend group number.
2. The physician does not have to be added as a Designee to the OPS BPS Secure account associated with the stipend group number.
3. The physician's H010A stipend claim must be submitted as a solo-provider MCEDT account under the new stipend group number.
4. We strongly recommend migrating to version 3 of HYPEMedical if you have not done so aleady.
Version 3 of HYPEMedical (HM53, HM43 or HM33) must be used to Create as well as Submit for the Stipend Physician Profile. Creating individual claims for the Stipend Physician Profile can be done on any version of HYPEMedical (including HM52, HM42, HM32, HM5, HM4 or HM3).
Log in credentials (user name and password) per user account are the same regardless of the HYPEMedical version used.

One-Time HYPEMedical Setup

Create a Stipend Physician Profile on Version 3 of HYPEMedical (HM53, HM43 or HM33) 

Rather than recreating the physician's entire setup, HYPEMedical allows you to clone the physician's existing profile.

Clone the Existing Physician Profile

  1. Go to:
    Doctors → Doctors Profiles → Setup
  2. Locate the physician who requires an additional profile for the anaesthesia stipend.
  3. Click the Clone icon on the far left of the physician's existing profile record. 

  4. Review and save the settings in each tab, making the following changes before activating the new physician profile:

Name Tab

Enter a new, unique Doctor Code so that you can distinguish the stipend physician profile from the physician's regular billing profile.
For example, you may wish to use a code that makes it easy for your billing staff to recognize the profile as the physician's H010A stipend profile.

MOH Tab

In the MOH tab:

    1. Enter the physician's applicable anaesthesia stipend group number in the Group Num field.
    2. Enter the site's corresponding Facility Num.
    3. Check the Force Submit Under Provider checkbox.
    4. Click Save.

Regions Tab

In the Regions Tab:
    1. Select the applicable Region.
    2. Click Save

Activate the Profile

Continue saving the applicable settings in each tab until you reach the:

Activate/Deactivate tab.

Activate the new stipend physician profile.

You will now have an additional HYPEMedical doctor profile for the physician:
  • the physician's regular doctor profile used for normal OHIP billing; and
  • the physician's stipend doctor profile, containing the anaesthesia stipend group number and related H010A submission settings.

How Many H010A Services Do I Bill?

Before creating an H010A claim, determine the physician's total eligible stipend time for the service date according to the Ministry's anaesthesia stipend rules.

Do Not Round Each Period Separately

If the physician has more than one period of eligible anaesthesia stipend time during the same day, do not round each period separately.

Instead:

  1. Identify all eligible stipend time for the service date.
  2. Add all eligible periods together.
  3. Determine the physician's total eligible time for the day.
  4. Round the daily total according to the Ministry's stipend rules.
  5. Use the resulting stipend tier/hours as the # of Services on the H010A claim.

Example

A physician has two periods of eligible stipend time during the same service date:
  • 2.6 hours
  • 3.7 hours
Add the eligible time together:
2.6 + 3.7 = 6.3 eligible hours
Apply the Ministry's rounding rules to the 6.3-hour daily total.
In this example, the physician qualifies for Tier 6.
The HYPEMedical claim should therefore be entered as:
H010A × 6 # of Services/hours
In other words:
H010A — # Servs.: 6
Do not round 2.6 hours and 3.7 hours separately and then add the two rounded amounts.
The eligible time is accumulated first. The resulting daily total determines the H010A stipend tier/# of Services/hours.

How to Bill H010A in HYPEMedical

Step 1 — Start the Claim

  1. Hover over Claims on the HYPEMedical menu.
  2. Select Create Claim.

  3. Select the Claim Details tab:

    Claims → Create Claim → Claim Details

  4. In the Billing MD field, choose the physician's new stipend doctor profile containing the anaesthesia stipend group number.

Be careful to select the physician's stipend profile, rather than the physician's regular billing profile.

Step 2 — Enter the H010A Service Code

Enter:

  • Service Code: H010A
  • # Servs: the applicable H010A stipend tieri/hours for that service date
  • Service Date: the date on which the eligible stipend time occurred

Example

If the physician's eligible daily time results in Tier 6, enter:

H010A — # Servs: 6


Can I Enter More Than One H010A Service on a Claim?

Yes.
A single HYPEMedical claim can contain multiple H010A service lines, with each line representing a different service date.

For example:

H010A × 6 — August 4
H010A × 8 — August 5
H010A × 5 — August 6
This makes it convenient to prepare several days of anaesthesia stipend billing together.
Each service line must contain the appropriate H010A # of Services for that specific service date.
Idea
Use the Multi date feature to select several dates after filling in the first H010A line item than revise the # Servs for each line.

Step 3 — Save the H010A Claim

H010A is not patient-specific, so regular patient demographics are not required for the stipend claim.

To save the claim:

  1. Click Save.
  2. HYPEMedical will display a warning because patient information is missing.
  3. Click Save Claim Anyways.

The H010A claim will be saved.

Submitting H010A Through MCEDT on Version 3 of HYPEMedical (HM53, HM43 or HM33) 

Submit your claims normally through HYPEMedical (version 3) along with your other physician profiles.

HYPEMedical Billing Tip: Create a "Stipend" Patient

H010A is not patient-specific, so HYPEMedical can save the claim without regular patient demographics.
The simplest method is to leave the patient information blank and click Save Claim Anyways.
HYPEMedical will then create an empty patient record for the non-patient-specific claim.
This works, but repeatedly doing so will result in unnecessary empty patient records.
A More Efficient Approach

When creating your first H010A claim, distinguish the otherwise empty patient record by entering a fictitious last name in the Last Name field of the Claim Details tab.

For example:
Last Name: Stipend
Save the claim.
HYPEMedical will create an easily identifiable patient record named: Stipend
For future H010A claims, simply search for and select the same Stipend record.

This allows you to keep your non-patient-specific anaesthesia stipend claims under one easily identifiable "patient" record, making it easier to:

  • prepare future H010A claims;
  • locate previous stipend claims;
  • review historical stipend billing; and
  • avoid creating multiple empty patient records.

Summary: H010A HYPEMedical Workflow at a Glance

Set Up Per Stipend Group

Clone the physician's existing profile
→ Create a new Doctor Code
→ Enter the anaesthesia stipend Group Num
→ Enter the corresponding Facility Num
→ Select Force Submit Under Provider
→ Select the Region
→ Activate the stipend physician profile

Calculate Each Service Date

Identify eligible anaesthesia stipend activity
→ Add all eligible periods for the day
→ Calculate the total eligible daily time
→ Apply the Ministry's daily rounding rules
→ Determine the H010A stipend tier

Create the Claim (any HYPEMedical version)

Go to Claims → Create Claim
→ Select the physician's stipend doctor profile
→ Enter H010A 
→ Enter the applicable #Servs 
→ Enter the Service Date
→ Click Save

Submit

Submit normally through HYPEMedical (version 3) along with your other doctor profiles' claims.

Frequently Asked Questions

How do I bill H010A in HYPEMedical?

Create a separate stipend physician profile containing the applicable anaesthesia stipend group number and facility number, enable Force Submit Under Provider, calculate the physician's eligible daily stipend tier, and enter H010A with that tier in the # of Services field.

Do I need a separate physician profile for H010A?

Yes. If the physician's normal HYPEMedical profile does not contain the applicable anaesthesia stipend group number, create an additional profile specifically for H010A stipend billing.

Where do I enter the anaesthesia stipend group number?

Go to:
Doctors → Doctors Profiles → Setup → MOH
Enter the stipend group number in the Group Num field.

What is Force Submit Under Provider used for?

For the H010A stipend profile, select Force Submit Under Provider so the claim can be submitted under the physician/provider as required while retaining the applicable stipend group information on the physician profile.

What do I enter as the Number of Services for H010A?

Enter the physician's applicable daily H010A stipend tier, calculated from the physician's total eligible stipend time for that service date.
For example, if the daily total results in Tier 6, enter:
H010A — # Servs: 6

Do I round each period of anaesthesia time separately?

No.
Add all eligible periods for the service date first. Then apply the Ministry's rounding rules to the daily total.

Does H010A require a patient?

H010A is not patient-specific. HYPEMedical can save the claim without normal patient demographics by selecting Save Claim Anyways when the missing-patient-information warning appears.

Can I create a fictitious patient for H010A?

Yes. Using a reusable record such as Last Name: Stipend can make it easier to prepare and find non-patient-specific H010A claims in HYPEMedical.

Can I put several H010A service dates on one claim?

Yes. A HYPEMedical claim may contain multiple H010A service lines, with each line containing the appropriate Service Date and # of Services for that day.

How do I submit H010A through MCEDT in HYPEMedical?

Once the stipend physician profile has been configured with the applicable Group Num, Facility Num, and Force Submit Under Provider setting, submit normally through HYPEMedical along with your other physician profiles.