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Primary Health Care Services InfoBulletins

To:  Family Health Organization (FHO)

Published by:  Negotiations Branch

Date Issued:  January 12, 2017

Bulletin Number:  11166

Re:  Home Visits: House Call Assessment Premium 85% Complex House Call Assessment 20% Payment

Posted Electronically Only

PDF Version Portable Document Format | 137 Kb


The 2012 Physician Services Agreement (PSA) between the Ministry of Health and Long-Term Care (MOHLTC) and the Ontario Medical Association (OMA) includes provisions for annual Year End Home Visits Payments under Appendix D 'Primary Care Initiatives' section 4.3 House Calls (c).

"When a FHO physician provides more than 68 House Calls per year to more than 17 patients (level C), all subsequent house call to home bound and frail elderly patients will be paid out of basket. Further, FHO physicians will also receive a 20% premium on the additional house call services if at least 75% of the house calls provided to their enrolled and non-enrolled homebound and frail elderly patients during the fiscal year."

The ministry has completed the calculation of this premium for the fiscal year April 1, 2015 to March 31, 2016.

Complex House Call Assessment 20% Payment

Physicians eligible to receive the payment are;

  • those who are signatory members of a CCM, FHG or FHN Group
  • have achieved a Level C Home Visits Special Premium (68 House calls to more than 17 patients)
  • have provided 75% of their Home Visits under the Fee Schedule Code A900A "Complex House call Assessment" to Home Bound Frail Elderly Patients

Physicians will receive an additional payment equaling 20% of the fee approved amount on the following Fee Schedule Code services provided over and above the level C service(s):

Home Visits
A900A Complex House Call Assessment
A901A House Call Assessment
A902A Pronouncement of Death – House Call

Physicians will receive an additional payment equaling 20% of the fee approved amount of any A###A code or K ###A code that is billed together with a B-Code Special Visit (same service date) over and above the level C service(s):

B-Code Special Visit
B990A Special Visit Premium
B992A Special Visit Premium
B993A Special Visit Premium
B994A Special Visit Premium
B996A Special Visit Premium

The payment will be made on the January 2017 Remittance Advice under the following accounting transaction:

  • "CHCA Complex House Call Assessment"

The Complex House Call Assessment payment is not subject to the 2012 PSA section 1.1

  • "the Parties agree to a payment discount of 0.5% on all physician payments in effect from April 1, 2013".

House Call Assessment Premium 85%

Physicians eligible to receive the payment are;

  • those who are signatory members of a FHO Group
  • have achieved a Level C Home Visits Special Premium (68 House Calls per year to more than 17 patients)

The A900A Complex House Call Assessment is a shadow billed/core service in the FHO model. The claims will remain shadow billed (paid at zero dollars with a payment explanation type code of "I2") and the Blended Fee for Service Premium which is 15% of the fee approved amount of the shadow billed claim will not be recovered.

Physicians receive an additional payment equaling 85% of the fee approved amount on the A900A Complex House Call Assessment services provided over and above the level C service(s).

The payment will be made on the January 2017 Remittance Advice under the following accounting transaction:

  • "HCAP House Call Assessment Premium 85%"

Thank you for your continued participation in advancing Primary Health Care in Ontario.

For any inquiries please contact the Service Support Contact Centre: 1-800-262-6524 or SSContactCentre.MOH@ontario.ca


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