Billing Tips for New Alberta GPs
— Resident to Practice Guide (2026)
New Alberta GPs routinely leave legitimate, earned revenue uncollected in their first year of practice — not from fraud or negligence, but from billing habits carried over from residency that don't apply to fee-for-service medicine. This guide walks through the seven most common mistakes and how to fix each one, using only PDF-verified SOMB 2026 codes.
The 7 Billing Mistakes — And How to Fix Each One
03.03A is a limited assessment ($40.23). 03.04A is a comprehensive assessment ($110.64) and requires a complete history, a complete physical examination, and a review of systems. New GPs carry over residency habits of thorough documentation but then bill the limited code — leaving the difference on the table on every annual health review.
If you performed a complete Hx + complete PE + ROS, bill 03.04A and make sure your note explicitly documents all three elements. If the encounter was focused on 1–2 problems, 03.03A is the correct code — don't upbill. Match the code to the scope actually performed, not the scope you could have performed.
03.01AD ($20.00) is the 'advice to patient' code — appropriate for brief phone/email/video advice. 03.03CV ($40.23) is the full assessment via phone/video — it requires a substantive history and clinical decision-making, equivalent to an in-office limited assessment. New GPs default to 03.01AD for everything virtual, even when the encounter was a full focused assessment.
If the virtual encounter included history taking, clinical judgement, and a management plan, bill 03.03CV. Reserve 03.01AD for brief advice interactions (e.g., 'result is normal, no action required'). Document modality explicitly in your note: 'Video visit — 12 minutes — full focused assessment performed.'
03.07A ($70.39) is a minor consultation. 03.08A ($131.40) is a comprehensive consultation — and requires (a) a referral from another physician, (b) a comprehensive assessment, and (c) a written report back to the referring physician. When all three are met, 03.08A is the correct code, not 03.07A.
For every consultation encounter, check: Is there a documented referral source? Did you perform a comprehensive assessment? Will you generate a written report? If yes to all three, bill 03.08A and save a copy of the written report in the chart as audit evidence.
When you perform a minor procedure during a visit — cryotherapy of keratoses (98.12L, $13.84), sebaceous cyst excision (98.12C, $38.56), IM injection (13.59A, $10.73), incision and drainage (98.03A, $16.69) — those procedures are billable alongside the visit fee, subject to SOMB co-billing rules. New GPs often bill only the visit and forget the procedure line entirely.
Keep a cheat sheet of the procedures you commonly perform with their verified codes. Add the procedure line at the time of the encounter, not after the fact. Review SOMB 2026 rules on same-day procedure + visit combinations — some combinations are allowed, others require a specific modifier, and a small number are mutually exclusive.
When a patient has an active WCB claim for a workplace injury, care related to that injury must be billed to WCB — not AHCIP. New GPs default to AHCIP out of habit and under-bill workplace injury encounters.
At intake for any occupational injury, verify whether the patient has an active WCB claim number. If yes, use the WCB billing pathway with WCB's own fee schedule. Never bill AHCIP and WCB simultaneously for the same injury. See our WCB billing guide for the full workflow.
Home visits have their own SOMB codes: 03.03N ($90.51) for the first patient seen at a residence, and 03.03P ($40.23) for each subsequent patient at the same residence. New GPs providing home visits — especially for palliative or housebound patients — sometimes bill a regular office visit instead and lose the differential.
When you see a patient in their home, bill 03.03N for the first patient and 03.03P for additional patients at the same visit. Document the location explicitly in the note.
Alberta Health's audit system flags statistical outliers. Without supporting documentation, even legitimately billed codes can result in clawbacks. Residency-style brief notes are an audit liability — Alberta Health wants to see the specific criterion that justifies each code.
For every code billed, make sure your note contains the audit anchor: for 03.04A, explicitly document 'complete Hx, complete PE, ROS'; for 03.03CV, document the modality and the substantive content of the assessment; for procedures, document the indication, the site, the consent, and the technique used.
Year 1 Quick-Start Billing Checklist
Complete this checklist in your first week of practice — before you bill a single claim:
Verified SOMB 2026 Codes Referenced in This Guide
Every code below is PDF-verified against the Alberta Schedule of Medical Benefits effective April 1, 2026. Fees are gross SOMB rates — your net depends on overhead and any associate splits.
| Code | Description | Fee |
|---|---|---|
| 03.03A | Limited assessment, office | $40.23 |
| 03.04A | Comprehensive assessment, office | $110.64 |
| 03.07A | Minor consultation, office | $70.39 |
| 03.08A | Comprehensive consultation, office | $131.40 |
| 03.03CV | Assessment via phone/video | $40.23 |
| 03.01AD | Advice to patient via phone/email/video | $20.00 |
| 03.03N | Home visit — first patient | $90.51 |
| 03.03P | Home visit — subsequent patient | $40.23 |
| 98.12C | Sebaceous cyst removal | $38.56 |
| 98.12L | Cryotherapy — warts/keratoses | $13.84 |
| 13.59A | IM/SC injection | $10.73 |
| 98.03A | Incision and drainage | $16.69 |
Co-billing rules, modifiers, and supplements apply. Always confirm against the current SOMB PDF before submitting.
Frequently Asked Questions
When can I start billing AHCIP in Alberta as a new physician?
You can bill AHCIP as soon as you have an active Alberta physician registration number and a valid billing number from Alberta Health. This is obtained through CPSA (College of Physicians and Surgeons of Alberta) registration followed by application to Alberta Health for billing privileges. Most new physicians can begin billing within 2-4 weeks of completing their licensing.
Should I hire a medical billing company or learn to bill myself?
Both approaches work. Billing companies typically charge 6-12% of recovered revenue in exchange for handling all submissions and follow-up. Self-billing gives you full control and insight into your revenue. Many new GPs start self-billing to learn the system, then delegate to clinic staff once established. The critical point: regardless of who submits claims, you should understand what is being billed in your name.
What is the most important SOMB document for a new Alberta GP to read?
Section 3 (General Practitioner and Family Physician Schedule) of the Alberta SOMB is your core reference. Pay particular attention to: the visit fee section (03.03A limited, 03.04A comprehensive), the consultation section (03.07A minor, 03.08A comprehensive), the virtual-care section (03.01AD, 03.03CV, 03.05JR), and any code with 'Notes' or 'Restrictions' that apply to codes you bill frequently. Read the 2026 version — the April 2026 update changed several values.
How do I know if I'm being underpaid by my clinic?
If you're an associate physician splitting fees with a clinic owner, obtain your remittance advice from Alberta Health directly and compare it to what you're being paid. You're entitled to see the full billing details for services rendered under your name. Unexplained discrepancies between AHCIP payments and your associate pay warrant a direct conversation with the clinic owner and potentially legal advice.
Related Articles
Related Billing Guides
Start Your Practice with Maximum Billing Accuracy
RevNote AI catches every complexity modifier, chronic disease code, after-hours premium, and mental health screening on every encounter. Built specifically for Alberta SOMB 2026. 10 encounters free — start today.
No credit card. No EMR integration. Works in 60 seconds.