The OHIP rejection code AT3, labeled as “No Pat-Phys Relationship,” can initially seem misleading. However, its implications are critical for billing compliance when it comes to virtual health care services in Ontario.
Clarifying the Requirements
According to Bulletin 221203 — Virtual Health Care in Ontario (source), comprehensive virtual care services must meet the following criteria:
- They must be rendered within the framework of an existing and ongoing patient-physician relationship.
- The encounter must comply with the criteria outlined in the Schedule.
If these criteria are not satisfied, claims for comprehensive virtual services will be rejected with the AT3 error code. This highlights the necessity for a recent physical interaction between the patient and physician to establish or maintain the relationship.
Key Considerations for Billing Comprehensive Virtual Services
To bill for a comprehensive virtual service, the following must be true:
- There has been a physical encounter between the physician and the patient within the past 24 months.
- The service adheres to the guidelines for comprehensive care as defined by OHIP.
If these conditions are not met, the service may qualify only as a limited virtual service. In such cases, the claim can be resubmitted under the appropriate billing code for limited services.
Preventing AT3 Rejections
To avoid rejections associated with the AT3 error code, it is essential to:
- Verify Patient History: Ensure that the physician has had a physical encounter with the patient within the past 24 months before setting up a virtual consultation classified as comprehensive.
- Use Proper Documentation: Maintain clear and accessible records of patient-physician interactions to validate compliance.
By addressing these factors, clinics can proactively avoid billing errors and ensure smoother claim processing.
How RexEMR-RexBill Simplifies This Process
The RexEMR platform incorporates a sophisticated rule engine that helps clinics avoid AT3 rejections by:
- Automating Patient History Checks: The system verifies whether a physical encounter has occurred within the required timeframe.
- Providing Alerts: RexEMR flags potential non-compliance scenarios before virtual consultations are set up.
- Optimizing Billing Practices: It ensures services are billed under the appropriate category—comprehensive or limited—based on the patient’s interaction history.
With these features, RexEMR streamlines the billing workflow, reducing errors and ensuring adherence to OHIP guidelines.
Conclusion
Understanding and addressing the criteria behind OHIP’s AT3 rejection code is vital for compliant billing of virtual health care services. By leveraging tools like RexEMR and maintaining meticulous patient records, clinics can minimize claim rejections and enhance their operational efficiency.