May 2025 RMA and OHIP News
- 10 min read
Every month, RMA compiles and summarizes the most important OHIP billing updates and RMA news for your convenience. May’s news is summarized below.
2024 Physician Services Agreement Year 1 Increase
INFOBulletin #250501 announces a 9.95% across-the-board compensation increase on physician payments for the period April 1, 2024 to October 31, 2024 as part of Year 1 of the 2024 Physician Services Agreement (PSA). Initially the payment was going to cover the period of April 1, 2024 to December 31, 2024; however there was a last minute modification by the ministry as a result of their internal payment processing system. The lump sum for the remaining two months (November and December 2024) will be paid no later than the August remittance advice. The details of all items covered in future compensation payments will be outlined in a subsequent infobulletin.
Payment is being made directly to the physician’s solo account. However, members enrolled in an Academic Health Sciences Centre (AHSC) alternative funding plan (AFP) will be paid 40% of the eligible retroactive amount from the ministry via their solo account on or about May 14, 2025. Per the terms of your AHSC contract, the remaining 60% will flow through your AHSC physician association (HAHSO). The 60% of funding will lag slightly behind the 40% as it goes through the conversion process; therefore, please contact your associated department for payment timelines.
Physicians will receive a compensation increase report from the ministry delivered to their solo account with the details of their compensation payment. To access your solo account, log on to OPS (Ontario Public Service) BPS (Broader Public Service) secure account by visiting https://www.edt.health.gov.on.ca, if you don’t know your OPS BPS Secure credentials, you can email ProviderRegistration.Moh@ontario.ca.
Relativity-Adjusted Physician Payment Increases
INFOBulletin #250406 announced that the ministry will apply relativity-adjusted increases to physician payments effective for service dates from April 1, 2025 to March 31, 2026 in accordance with the Arbitration Award for year 1 of the 2024-28 physician services agreement (PSA). The relativity-adjusted payment will be made on the monthly remittance advice (RA), beginning on the June RA and the first payment will be applied to the June statement of earnings. All members will receive a relativity summary report from the ministry delivered to their solo account with full details. To access your solo account, log on to OPS (Ontario Public Service) BPS (Broader Public Service) secure account by visiting https://www.edt.health.gov.on.ca, if you don’t know your OPS BPS Secure credentials, you can email ProviderRegistration.Moh@ontario.ca.
The distribution of the relativity-adjusted increases by specialty are determined by the individual physician’s derived specialty as set out in table 1. The distribution of the relativity-adjusted increases by payment type can be found on table 2. RMA is awaiting clarification from the ministry regarding the specifics of table 2 and will provide an update when the June RA is released.
What is a derived specialty?
A derived specialty is assigned by the ministry based on physician billings from April 1, 2024-March 31, 2025. For physicians with multiple specialties, your derived specialty is determined by the billing specialty associated with claims that had the highest total billings (paid and shadow billed). A physician may only be assigned one derived specialty. Exceptions apply to physicians with family or general practice specialty (00) who receive payments through various payments models, emergency medicine specialty (12 or 00) and critical care medicine specialty (11 or physicians billing FFS > 50% in critical care per diem codes).
Note: Physicians who did not have claims from April 1, 2024-March 31, 2025 will initially be assigned the 9.96% global rate until a derived specialty can be determined based on their 2025/26 (April 1, 2025-March 31, 2026) claims.
APP Base funding
Effective April 1, 2025, the base funding for Specialist Physician Alternative Payment Plan (APP) payments will be increased by a relativity-adjusted percent or other percent agreed to by the parties. The outstanding 9.95% related to 2024/25 will be issued in two sums – one for base funding and one for shadow billing. Further details will be provided in a future INFOBulletin.
Visits Related to a Surgical Procedure
There has been a significant increase of denials relating to assessments when billed on the same day as a major surgical procedure. Other than the major pre-operative visit, assessments on the day of surgery are included in the surgical procedure or anaesthesia service and not separately payable.
- Major pre-operative visit – the consultation or assessment where the decision to operate is made, regardless of the time interval between the major preoperative visit and the surgical procedure.
- Independent operative procedure (IOP) – a procedure code with a Z-prefix.
Services NOT ELIGIBLE for payment to the primary surgeon in addition to a surgical procedure are as follows:
- Inpatient hospital visits two (2) days prior to and the day of the surgical procedure.
- Assessments on the same day of a surgical procedure, unless the assessment is the major pre-operative visit as defined above.
- As no assessment is eligible for payment on the day of surgery, travel and first person seen special visit premiums are not eligible for payment.
Services ELIGIBLE for payment to the primary surgeon in addition to a surgical procedure are as follows:
- The first two (2) post-op visits in hospital (payable at the specialty specific subsequent visit fee code).
- Day of discharge (C124/E083), if admitted for 48hrs.
Common mistakes are billing C122/C123 and C142/C143 as the first two (2) post op visits and billing discharge the day following admission.
Services ELIGIBLE in addition to a Z-PREFIX (IOP) procedure are as follows:
- Major pre-operative visit.
- Partial assessment to an out-patient, if the major pre-operative visit was rendered in the previous 12 month period by the same physician.
- Inpatient hospital visits.
When performing as the assisting surgeon:
- Assessments on the day of surgery is not eligible for payment unless it is the major pre-operative visit; which is expected to be rendered by the primary surgeon and not the surgical assistant. An assessment may be payable if rendered for a separate and medically necessary reason on the day of surgery (e.g. called for an intra-operative consult, then assisted the procedure). In this circumstance, the claim should be flagged for manual review with documentation supporting that the assessment was not a routine element of the surgical procedure.
Anaesthesiologist:
- The anaesthesia service includes the pre-anaesthetic evaluation, the anaesthetic procedure and post-anaesthetic follow-up in the recovery room; therefore, an assessment same day is not payable unless it is the pre-operative assessment. A medically necessary assessment rendered outside the recovery room (post-anaesthetic) may be eligible same day.
See EPC Billing Brief found here for full details
Polypectomies via Colonoscopy
The ministry released an EPC Billing Brief to assist in correct coding of polypectomies via colonoscopy.
To minimize rejections, please ensure the following claim submission rules are followed:
- Choose one of Z571, Z518, Z517 or Z516 which represents the largest polyp removed.
- Z571 – excision of first polyp (3-5mm)
- Z518 – excision of first polyp (6-9mm)
- Z517 – excision of first polyp (10-19mm)
- Z516 – excision of first polyp (20-29mm)
- In cases when multiple polyps are excised, add appropriate E code(s) according to each additional polyp size, to a maximum of 2 services per day.
- E720 – each additional polyp (3-5mm)
- E520 – each additional polyp (6-9mm)
- E519 – each additional polyp (10-19mm)
- E518 – each additional polyp (20-29mm)
- Example – three polyps were excised (21mm, 10mm and 9mm). Z516 represents the largest polyp; therefore, the following should be billed:
- Z516 – excision of first polyp (20-29mm)
- E519 – each additional polyp (10-19mm)
- E520 – each additional polyp (6-9mm)
- A maximum of 2 additional polyp E codes services of any combination is eligible for payment per patient, per day. Billing in excess of this maximum will result in a rejection.
Victoria Day Holiday Premium
This year Victoria Day falls on Monday, May 19. Please ensure that you add the appropriate premium to your claim if called on an emergency, for a non-elective visit, surgery, anesthesia or assisting as this will increase the dollar value of your claim. Non-elective means the assessment of the patient is urgent and unscheduled and cannot wait more than 24 hours.
Premiums do not apply to elective visits to in-patients (e.g., rounds).
2024 Payment Summary
Payment summaries for the 2024 calendar year (January 1, 2024 – December 31, 2024) were released at the end of February 2025. This document details the payments that were deposited to you from RMA during this time period. These statements will aid you in your tax preparation for unincorporated physicians and those with a corporate year end date of December 31st. In order to obtain your payment summary logon to the RMA portal, click “My RMA Reports” (on the left hand tool bar), click “Annual Payment Summaries.” You will see “RMA 2024 Payment Summary”. If you have forgotten your logon credentials please reach out to Tania Marini ciccagl@mcmaster.ca
Notice of HHS Parking in Arrears
Recently a number of parkers at HHS locations have received an email from the parking office indicating their parking is in arrears. This is due to a billing system update (completed by HHS) which prompted a review of all HHS parkers’ billing information. Upon this review it was found that some parkers were not being billed. For those that were not billed, HHS has requested payment for the 2024/25 parking year (April 1, 2024 – March 31, 2025), even though a parker may have not been paying prior to this period.
As a reminder, parking fees are an eligible ABE for those that have opted into the service. Should you receive an email from HHS parking indicating your parking is in arrears, you may forward this email to Kenny Mugaya (mugayak@mcmaster.ca) to have this expense paid on your behalf.
2025 CPSO Renewal
Your 2025 CPSO renewal application form including the questionnaire must be completed online at www.cpso.on.ca. Online renewal is the only way to renew. Please ensure CPSO has your current email address on file. You should have received the renewal notice via email in early to mid April.
Once you have completed the renewal form please print and scan your invoice / screenshot of the amount owing to RMA for payment OR pay your fees online and send in your receipt for reimbursement. If you are requesting payment to be sent on your behalf this must be communicated by noon May 22, 2025 in order to do so. You will be charged a late fee if your online renewal and payment are not received by June 2, 2025. The late fee is not eligible for reimbursement.
Please forward your invoice or receipt to Kenny Mugaya at mugayak@mcmaster.ca for payment or reimbursement.
2024 Tax Preparation
Tax preparation services are a part of your Allowed Business Expenses (ABE’s). These services are meant for RMA members only and not for your family or spouse. If you have several tax returns prepared by the same accountant, please ensure your invoice is itemized.
Note: these invoices will be paid only if there are sufficient funds remaining in your 2024/2025 variable ABE account. Please reach out to Kenny Mugaya at mugayak@mcmaster.ca to find out the remaining balance in your variable ABE account.
Please send your invoice for payment to Kenny Mugaya at RMA or via email mugayak@mcmaster.ca
2025 CMPA Fee
You should have received an email from CMPA regarding your 2025 CMPA fees. Under payment method at the bottom left of your invoice you will see your payment options stated as one of three below:
Annual pre-authorize debit
Annual payment will be debited from your bank account on May 1 annually and participating in the MLP malpractice program receiving your CMPA rebate from the MOHLTC every April under option “A”.
Monthly pre-authorize debit
Monthly payments will be debited from your bank account on the 20th of each month. You should be participating in the MLP malpractice program receiving your CMPA rebate quarterly from the MOHLTC every April, July, October and January under option “B”
Annual Online payment
Payment is due online by January 1 each year. You should be participating in the MLP malpractice program receiving your CMPA rebate every April from the MOHLTC under option “A”.
For physicians with an Allowable Business Expense account you can send your CMPA Statement of Account after your payment has been made and either your CMPA Statement of Reimbursement or a copy of your CMPA rebate letter showing the amount you received. Please note, without the CMPA rebate letter RMA will not be able to reimburse your CMPA fees until the CMPA reimbursement schedule is released. As a reminder RMA reimburses your out-of-pocket expense which is CMPA fees less the CMPA rebate.
2025 Malpractice Rebate Program (CMPA Rebate)
Physicians receive reimbursement confirmation letters in the mail prior to their reimbursement being deposited confirming the amount and deposit date. If you need to change your banking information for your 2025 deposit please fill out this form and send along with your new banking information to the MLP reimbursement program. You can email it to them directly and they will send you an email confirmation reply.
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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