With busy clinic days and administrative tasks piling up, managing and charging for services not insured by OHIP can add an extra burden on medical practices, leading them to miss out on well-deserved revenue.
In Ontario, the most frequently requested uninsured service is handling prescription renewals faxed in by the pharmacy upon the patients’ requests. Although this is a relatively simple uninsured service, the high volume of daily requests results in a time-consuming task for both staff and physicians.
Here is the process that most physicians go through for renewing prescriptions for patients:
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Receive faxed request.
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The requested renewal is added to the patient chart.
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The physician reviews the request to determine if the patient needs a visit before renewal and necessary documentation is added to the patient’s medical file.
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The prescription is faxed to the pharmacy.
Since physicians do not get paid by OHIP for prescription renewals, they will have to charge patients out of pocket for these services, for which the Ontario Medical Association (OMA) suggests a rate of $25 per patient. This situation can create numerous barriers and challenges for physicians, as many find it overwhelming to manage, or even decide not to charge for these requests altogether.
Challenges Faced by Physicians When Handling Prescription Renewals
Imagine this scenario: A doctor is swamped with patient appointments, running 30 minutes to an hour late, and prescription renewal faxes are piling up. With barely any time to assess the renewals between visits, they are continually delayed. Patients frequently call to check on the status of their signed renewals.
Over the weekend, when the doctor finally has a moment to review these requests, they realize half of the patients require a virtual/in-person visit before prescriptions can be renewed. The doctor will need to instruct their staff to contact these patients for appointments. The remaining requests are then forwarded to the pharmacy, but in the end, the extensive time spent handling renewals is not being compensated for.
In this chaotic practice, not only is time not utilized effectively, but hard-earned revenue is being left on the table.
Challenge #1- Lack of Patient Awareness
Often, doctors choose not to charge patients for prescription renewals for various reasons, including:
- Doctors believe patients are unlikely to pay for these services.
- They feel uneasy about educating patients and charging them.
- They lack the time and resources to issue invoices and collect payments.
Over time, this poses a significant challenge. When patients remain unaware of the costs associated with prescription renewals, physicians continue to allocate valuable time and resources to manage these requests without appropriate compensation.
Challenge #2- Auto-Renewals from Pharmacies
Furthermore, one of the main reasons physicians receive such a high influx of faxes from pharmacies is that many pharmacies likely have patient prescription renewals set up for auto-fax, automatically sending the doctor a prescription renewal request close to the end of the patient refill or at the patient’s request. Many pharmacies may not be aware that renewals are time-consuming and require additional work to be completed on the doctor’s end.
Patients may also end up paying for prescription renewals they did not request or for medications they no longer need due to pharmacies sending auto-faxes, which can lead to frustration.
Challenge #3- Collecting Fees from Patients
Many physicians feel uneasy about charging patients for uninsured services. This hesitation often comes from several factors, such as uncertainty about their patients’ financial situations, assumptions that patients may be unable to afford the renewal, and concerns about potential pushback. These common reasons explain why many doctors decide not to charge for these services.
Additionally, when a clinic’s uninsured services management infrastructure is inadequate, it results in inconsistent patient reminders. Patients often disregard invoices, and physicians risk losing out on compensation without an established system—such as appointing a specific person to follow up on payments.
Challenge #4- Prescription Renewals are Time-Consuming
Doctors receive multiple faxes daily, and with the four-step process for renewing prescriptions mentioned previously, it takes approximately 10-15 minutes per patient to renew a prescription. This is a lot of time spent in a physician’s day that should be redirected to patient care.
If the requested medications are on backorder, they may need to be temporarily substituted with an equivalent. There may be a back-and-forth exchange between the physician and the pharmacist, which increases the time spent on a single patient’s prescription.
Patients often renew their prescriptions just before or at the end of their current supply. This last-minute timing creates unnecessary stress for patients waiting for their prescriptions and for doctors rushing to renew them.
Prescription Renewal Best Practices
Considering all of this, how should doctors respond to these challenges?
Solution #1– Patient Education
Many patients are unaware that OHIP does not cover prescription renewals and is considered an uninsured service. This is when patient education plays an important role. Patients who know the costs associated with prescription renewals are much more likely to be receptive.
There are various methods to educate your patients, including communication channels like letters, regular emails, posters in the clinic, and updating your clinic’s website to include this information.
Additionally, setting patient expectations is crucial: Clarify that patients might still need a medical assessment before renewals and ensure they inform you about upcoming renewals at least a week in advance.
Solution #2- Informing Patients to Coordinate with their Pharmacy
Encouraging patients to coordinate with pharmacies is an effective way to keep them informed about the clinic’s policies on charges while prompting pharmacies to be more mindful of unnecessary faxes. By advising patients that their pharmacy might send automatic fax renewals which may result in charges they did not request – will encourage patients to ask their pharmacy to disable the auto-fax.
Moreover, some pharmacies charge for short-term prescription refills even without a signed renewal from the doctor. This practice may help reduce the number of patients requesting last-minute renewals.
Solution #3- Introduce Block Fees into Your Practice
Many doctors charge fee-for-service for prescription renewals. However, streamlining payment methods can create smoother transactions for doctors and patients. Instead of billing each service separately, doctors should consider a block fee program as an easy alternative to manage prescription renewals. A block fee involves a flat rate encompassing an array of uninsured services for one year.
Block fees offer:
- Convenience for patients by eliminating the need to handle individual payments and reducing financial stress.
- Predictable revenue for physicians by stabilizing their revenue stream, reducing the uncertainty associated with fee-for-service billing.
- Time-saving administrative processes associated with handling payments.
When a block fee has been implemented, giving your patients one month’s notice before it goes into effect is a good idea.
We have extensive expertise in this area, and many of our doctors have found that this option works best for their practices. For many patients, paying one annual fee is easier than dealing with the hassle of multiple invoices. This is particularly true for patients who know that they will utilize several non-OHIP covered medical services throughout the fee period.
Solution #4- Hire a Third-Party to Handle Uninsured Services
Once you understand the ins and outs of managing prescription renewals and handling patient payments, it is wise to designate a staff member for this responsibility. However, adding this duty to their existing workload could leave them less time for other administrative clinic tasks.
Our team at Doctors Services Group helps practices save time and improve patient satisfaction by managing the administrative burden of implementing an uninsured services billing program and, in turn, reducing the administrative workload for physicians and their staff.
We offer:
- Patient Education: We help educate your patients about uninsured medical services through comprehensive, customized channels and personalized patient communication.
- Full-Service Administration: Our platform is customizable to meet the specific needs of your practice.
- Revenue Generation: In 2024 alone, we were able to recover $16,000 of additional revenue per physician.
These services allow physicians to align their value with the financial implications for patients while recovering costs.
Success Story: Streamlining Renewals
The administrative burden placed on family medicine practices significantly impacts their ability to deliver quality care while trying to maintain efficiency. Handling prescription renewals is one of the many burdensome tasks that detract from patient care. But it doesn’t have to be this way!
Take it from Anne, the medical office manager at a family medicine practice in Oakville. She recently shared how our uninsured service program changed their operations. We effectively minimized the extensive administrative burden of processing payments for prescription renewals, allowing the physician to devote more time to patient care and maximize revenue.
We were lucky DSG came to us. Their representative provided us with ideas and a plan we were curious to explore. We decided to sign on with DSG two years ago and have not looked back!
Read Anne’s full interview here.
Are you seeking assistance with managing uninsured services for your practice? Let’s talk! Doctors Services provides support for follow-ups, invoicing, block-fee administration, and real-time program information, allowing physicians to streamline their operations.
Reach out to us at info@doctorsservices.ca to book a complimentary uninsured services assessment and recoup missed and well-deserved revenue today!
