June 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. June’s news is summarized below.
RMA Yearend – June 30 2025
Our year-end of June 30 is fast approaching. Please be sure to have all your billing up to and including service dates of June 30, 2025 to our office by no later than Wednesday, July 2, 2025 at 12:00 noon. This includes paper-based, Web-STAR and all electronically submitted billings. Any billing received after this time will be processed in the new fiscal year.
Web STAR users: Please enter your billing on a regular basis. Final extraction of claims will take place on Wednesday, July 2, 2025 at 12:00 noon.
Cash, Cheques, Direct Deposits, EFTs to RMA: Please make sure all deposits and payments are submitted to our office or bank account by Thursday, June 26, 2025 at 12:00 noon to ensure that the funds are reflected in your June Year End statements.
ABE’s: Please submit by Wednesday, July 2, 2025 at 12:00 noon.
Health Card Validation Reminder
INFOBulletin #250502 sends out a reminder to all providers to verify and validate their patient’s health card/version code at each encounter to help reduce the number of claims that are rejected due to patient ineligibility. Incorrect version code remains as the biggest reason for a claim rejection. Please remember when entering your billing to ALWAYS CHECK THE VERSION CODE FOR EACH PATIENT and update Web STAR and/or your EMR software. For virtual visits, verify the patient’s health card/version code at the start of the visit and if there is a change, ensure that this information is updated or passed on to your entry person. With the stale-date limitation decrease to three months, there is a very short window to obtain, correct and resubmit rejected claims. If a claim is resubmitted AFTER the stale-date period, it is still eligible for payment, however, these claims must be submitted through the ministry’s rigorous and time-consuming process which delays payment by several more months. Submitting your billing as soon as possible after the service has been provided and with the most current version code will reduce claim rejections and any delay in payment.
Reducing Claim Rejections to Expedite Payment
Rejected claims that require correction through a remittance advice inquiry typically takes a minimum of 6 months for the ministry to action from the time the inquiry is sent. As such, the following are common issues to be aware of to prevent a rejection and expedite payment.
K070 – Home Care Application
K070 is payable once per home care admission. Although there is no limit to the number of services allowed in a specific time period, claims for K070 (by any physician) in excess of one service per 6 months must be flagged for manual review with an explanation. It has been our experience that Claims Assessors at the ministry require the home care application form in order to consider payment. If you are aware of a second home care admission within 6 months, please flag your claim for manual review and forward the home care application. A common scenario for this type of rejection is a second surgical procedure (e.g. joint replacement) within 6 months. Please note, K070 is not payable when orders are changed or when home care is reactivated after being temporarily paused. The patient must have previously been discharged from home care and a new admission instated.
Special, Comprehensive and Extended Consultations
The start and stop times of any minimum time-based consultation must be recorded in the patient’s medical record. If your consult note needs to be submitted to support your claim, absence of both start and stop times will result in denial of your consultation.
Special visit premiums
Issue #1: Claiming weekend/holiday special visit premiums when the service date is a weekday or is not a defined holiday as per GP3 (example Remembrance Day).
Issue #2: Claiming travel premium with additional person seen premium e.g. A135 + C963 (travel) + C987 (add’l person).
Issue #3: Claiming incompatible premiums that are listed in different time/date period columns e.g. A135 + C963 (weekend travel) + C994 (first person seen evening 1700-2400hrs).
Please keep the following in mind when applying special visit premiums to your claim:
- Apply the appropriate premium according to start time and/or date of the special visit as documented in the medical record.
- Identify if the travel premium is eligible and/or required. If the physician was required to travel to see their first patient for an urgent visit, both the travel premium and first person seen premium must be claimed (e.g. A135, C962, C994). If the physician was not required to travel, the first person seen premium may still be eligible.
- Weekday daytime (0700-1700) premiums require travel (e.g. K990). If the requirement of travel is not met, special visit premiums during this period are not eligible. The exception is sacrifice of office hours (e.g. K992) which does not require travel to be eligible.
- Only one travel premium is eligible for payment for each separate trip regardless of the number of patients seen during same trip (up to the maximum specified in the table per day).
- Claim additional person seen premium that corresponds to the start time and/or date of the special visit when additional patients are seen urgently during the same trip. Do not claim travel with additional person seen premium.
See GP65-GP78 in the schedule of benefits for full details.
K002 – Interview with relatives
K002 is not payable in addition to an outpatient consult or assessment as the inquiry, discussion or provision of advice or information to a patient, patients relative or representative is an included element. If the interview was separately booked, K002 may be eligible in addition to an inpatient service. Be sure to document this in the medical record along with the start and stop times. In the event there is an issue with your claim, and this is not supported in the medical record the ministry will not pay.
See GP61 in the schedule of benefits for full details.
C142 and C143 – Subsequent visits by the MRP following transfer from an Intensive Care Unit (ICU)
- C142 and C143 are eligible when the MRP provides a subsequent visit following transfer from an ICU.
- C142 and C143 have a maximum of one per hospital admission, and cannot be claimed more than once even if the patient is transferred in and out of the ICU multiple times.
- C142 and C143 are typically claimed when the patient is admitted directly to the ICU, as such only one of C122 or C142, or one of C123 or C143 may be claimed during the same admission.
- If you are the MRP claiming per diem codes when the patient is in the ICU, you are not eligible to claim C142 or C143 when the patient is transferred to the ward, however, you may claim MRP subsequent visits.
See GP46 in the schedule of benefits for full details.
Third-Party Insurers and Compensation Increase Effective April 1, 2025
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 specialty-specific increases do not appear within the Schedule of Benefits. Instead, they will add the increase as a separate line on the Remittance Advice, which has led some third party insurers to overlook them. As such, it is the OMA’s recommendation to invoice third party insurers to include the general increase of 12.75% with the exception to following specialties that have a higher relativity increase:
- Neurology (18): 13.39%
- Psychiatry (19): 13.85%
- Infectious Disease (46): 13.57%
For service dates effective April 1, 2025, RMA will start to invoice third party insurers at the following rates and will closely monitor how each insurer remits payment.
- OHIP Rate (IFH/OHIP rated claims)
- 2025 OHIP rate × general % increase OR specialty % increase as indicated above = New OHIP rate
- OMA Rate
- 2025 OHIP rate × general % increase OR specialty % increase as indicated above × 2.88 OMA multiplier = New OMA rate
- UHIP Rate
2025 OHIP × general % increase OR specialty % increase as indicated above × 1.25 UHIP multiplier = New UHIP rate
Education and Prevention Committee (EPC) Billing Briefs for E550, Z363, and K133
The MOH released three EPC billing briefs to advice physicians when it is appropriate to bill E550, Z363 and K133.
E550 – insertion of closed irrigation system during a surgical procedure for post-operative management
E550 is only eligible for payment for insertion of a closed irrigation including inflow and outflow tubes during a surgical procedure for post-operative management related to the musculoskeletal system. As such, common claim concerns have been identified as follows:
- Claiming E550 for application of any type of topical negative pressure wound dressing system (i.e. VAC dressing) with or without automated topical wound solution instillation and removal.
- Claiming E550 for insertion of a continuous bladder irrigation system.
- Claiming E550 for irrigation and/or dressing of laceration or for laceration suture/repair.
For more details, see EPC brief found here.
Z363 – removal of thoracostomy tube (chest tube)
Z363 is for the removal of chest tube with wound closure on a service day other than the day of insertion. As such, Z363 is not eligible for the following:
- On the same day as fee code Z341 (chest tube insertion),
- On the same day as a surgical procedure that includes the placement of one or more chest tube(s), or
- For removal of drains other than thoracostomy tubes.
For more details, see EPC brief found here.
K133 – periodic health visit for adults with Intellectual and Development Disabilities (IDD).
K133 is a service performed on an adult (a person 18 years of age and older) with IDD that consists of an intermediate assessment and associated planning/management for the purposes of screening and health maintenance, consistent with the current Canadian consensus guidelines on the primary care of adults with IDD. K133 is a service that can be completed over multiple days. As such, the date of service is defined as the last date for which all elements of the K133 service were completed.
For more details, see EPC brief found here.
Update to MedsCheck Program Notification Requirements
INFOBulletin #250503 announced effective May 26, 2025, pharmacists are no longer required to send the MedsCheck Personal Medication Record to a patient’s primary prescriber using a standardized notification letter/fax template if no follow up issues are identified during a MedsCheck and no actions are required by the prescriber.
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.
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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