Alberta physicians leave significant revenue on the table through billing errors that are individually small but add up over weeks and months. Most of these aren't knowledge gaps — they're workflow gaps. The physician knows the rules but misses the detail under time pressure.
This page covers the most common billing mistakes Alberta physicians make with SOMB codes, modifiers, and documentation — and how structured review catches them.
This is the single most common revenue leak in Alberta physician billing. A companion code is a secondary billable element that accompanies a primary procedure or encounter — but only if you remember to bill it.
Examples:
Why it happens: The primary encounter code is obvious. The companion code requires a second thought — and under time pressure, that second thought doesn't happen.
Alberta SOMB provides after-hours premiums for encounters occurring outside regular hours — evenings, nights, weekends, and statutory holidays. The premium varies by time band and code eligibility.
Why it happens: Billing is often done the next day, when the time context is lost. The physician remembers the encounter but not the time band. Or they're unsure which codes qualify for after-hours premiums and default to not applying them.
The cost: After-hours premiums can represent a meaningful percentage increase on eligible codes. Over a year of on-call or evening clinic work, the cumulative missed revenue is substantial.
When multiple procedures are performed in one encounter, the modifiers applied to secondary procedures differ from those on the primary. Applying the wrong modifier — or no modifier at all — creates either underbilling or audit risk.
Common errors:
Billing a code is only defensible if the chart documentation supports it. Common documentation-related billing mistakes include:
Why it matters: In an audit, the billing code is only as defensible as the chart note. If the documentation doesn't support the code, the physician faces a clawback — and potentially a pattern review.
Multi-procedure encounters are governed by GR 6.9.7, which adjusts fees based on procedure table classification, incision type, and additional benefit exemptions. Miscalculating these adjustments is common because the rules are genuinely complex.
Common errors:
When the same procedure is performed on both sides of the body, the bilateral modifier applies. This is commonly missed in orthopaedic, ophthalmology, and dermatological encounters.
Why it happens: The physician bills the procedure once and moves on. The bilateral modifier requires an active decision to apply it.
The distinction between a consultation and a follow-up in Alberta billing has specific documentation and referral requirements. Billing a follow-up when the encounter qualifies as a consultation means underbilling. Billing a consultation without meeting the documentation threshold means audit risk.
Most of these errors share a common root cause: the physician knows the rules but doesn't have time to apply them systematically to every encounter. A structured review process — whether manual or AI-assisted — catches errors by: