OHIP Billing Resources: Diabetes Management Codes
Helping patients manage diabetes takes time, billing for it shouldn’t. Use these resources to simplify your workflow and ensure accurate compensation for the care you provide.
Blog: OHIP Billing: A Guide to Diabetes Management
Understanding billing codes like K030 and Q040, and how to bill for diabetic care is important to ensure you are being paid correctly for the care you are providing. In this blog, we share tips and tricks on how to effectively bill for your diabetic patients.
Quick Reference Guide: Diabetes Management
Managing diabetic patients requires a proactive approach from physicians to ensure optimal care. This quick guide provides practical insights on how to bill for diabetes-related services, helping you streamline your billing and maximize revenue.
Diabetes Management Flow Sheet
The Diabetes Management Flow Sheet is a required document for accurate tracking of your diabetic patients’ conditions. Completing it ensures compliance and enables you to receive full payment for eligible diabetes-related OHIP claims.
Diabetes Billing - Frequently Asked Questions
There are three main fee codes that physicians bill when managing their diabetic patients:
- K030 – Diabetes Management Assessment
- Q040 – Diabetes Management Incentive
- K029 – Insulin Therapy Support
These billing codes are considered out-of-basket and are paid at the full fee-for-service rate based on the Schedule of Benefits.
Yes, you can; however, it’s important to note that the first K030 billed for a patient in each 12-month cycle must be for an in-person visit. If it’s not, the claim will be rejected, and the assessment will not count toward diabetic management.
Best practice is every 3 months. This supports both optimal care and eligibility for Diabetes Management Incentive Q040.
By proactively recalling and tracking diabetic patients, you will be able to bill the Diabetes Management codes at the right time. This approach increases your potential earnings on a standard-sized roster of diabetic patients.
For example, if you have a roster size of 1,300 patients and 136 of your patients are diabetic (based on Diabetes Canada, around 10% of patients require diabetic management).
If effectively managed, a diabetes recall system can yield approximately $216 per rostered patient. With 136 patients at $216 per patient, you would be making an additional $30,000 a year for seeing those patients.
In essence, effectively tracking your diabetes patients not only enhances the continuity of their care but also generates more revenue for the physician.
Physicians in the FHO, FHG, FHN, CCM and FFS payment models are all eligible to bill the Diabetes Management codes and incentives.
Diabetes Management Support from DoctorCare
Diabetes management requires considerable time and effort to ensure that patients are being recalled for their visits. DoctorCare can help you with effectively managing your diabetic patient recalls making sure you can maximize your revenue potential with minimal effort required on your part.
With our service, Patient Care, we will identify patients who have not been seen in over 3 months – right from your EMR. We will then conduct monthly diabetic recalls as well as help you set up the process for recalling patients on your online booking system.
