Six Important OHIP Billing Updates in August 2024
- 3 min read
Every month, RMA compiles and summarizes the most important billing updates for the convenience of you – the healthcare providers. This month, there were six important OHIP billing updates for physicians.
Anaesthesia Consultations
INFOBulletin #240701 announced an update to the OHIP claims payment system to ensure correct payment of claims containing fee codes A210A and C210A for special anesthetic consultation.
Within this bulletin you will find the payment rules applied and the claim submission guidelines. The update to the OHIP claims payment system was implemented on July 1, 2024, effective for service dates April 1, 2023. Due to the staged implementation, a Medical Claims adjustment (MADJ) was performed. No action required.
INFOBulletin #240801 announced that a Medical Claims adjustment (MADJ) was required to reprocess claims containing A210 and C210 for special anesthetic consultation. This is reflected on the August RA. A MADJ means that the ministry will reprocess all such claims through their claims payment system to ensure the claim conforms to the rules and adjust any denials accordingly. As a result of the MADJ, affected claims will have explanatory code 55/57 (deduction or payment made on earlier account) for reconciliation purposes posted to the July and August remittance advice and Web STAR. Due to the way in which the RA is applied to Web STAR, the full claim payment may not be displayed; therefore, please refer to your July and August RA. There is no payment impact and action is not required except if the claim was originally submitted incorrectly. In that case, RMA will communicate as needed.
Thoracic Surgery Procedures
INFOBulletin #240702 announced that a Medical Claims adjustment (MADJ) was required to reprocess claims containing thoracic surgery procedures (Z352A and Z363A), extended specific neurocognitive assessment (K042A) and assessment of pediatric patient with amblyopia (E424A). This is reflected on the July remittance advice (RA).
COVID-19 Advance Payment Program
In response to the COVID-19 pandemic, INFOBulletin #4754 announced the COVID-19 advance payment program to address cash flow issues in April 2020. Advance payments were made to a physician’s MOH Solo Account in May, June and/or July 2020 if they qualified during that month.
INFOBulletin #230701 announced that the MOH will resume the advance payment recovery process in August 2023. The loan repayment will be applied against a provider’s future OHIP payments through their Solo Remittance Advice (i.e. claims submitted direct to the MOH). Loan repayments cannot be made via a physician’s RMA Group account as the loan was provided outside of the practice plan.
Solo Billing
INFOBulletin#240703 announced that providers with insufficient earnings on their Solo remittance advice had the final amounts owing, if any, reflected on the July 2024 solo remittance advice as a negative balance. The ministry recommends that all providers reference their July 2024 remittance advice to determine if there are any amounts owing and, if necessary, to verify the correct repayment amount required. For questions or concerns related to the repayment, please email SSContactCentre.MOH@ontario.caor call 1-800-262-6524. Have your OHIP provider number readily available prior to calling.
To view your Solo RA, you will need to access your MOH GoSecure account through the Ministry. If you know your GoSecure unique identifiers, you may login or sign up here. If you do not know your GoSecure unique identifiers, you can email ProviderRegistration.Moh@ontario.ca and include your 6-digit billing number.
For more information...
RMA has over 40 years of experience and expertise in the medical billing field. Our staff is always happy to help update physicians on the latest billing news. If you want more specific information on each INFOBulletin, check out the official website.
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