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Ministry Status: Routine Monitoring and Engagement

Ontario Health Insurance Plan

OHIP Bulletins


INFOBulletin

Keeping Health Care Providers informed of payment, policy or program changes

To: St. Joseph’s Health Centre Physicians

Published by: Negotiations Branch, Ministry of Health and Long-Term Care

Date Issued: February 21, 2018

Bulletin Number: 11187

Re: Automation of Base Rate Payment

Posted Electronically Only

PDF Version Portable Document Format | 1 Mb | 


Overview

Effective February 2018, the Ministry of Health and Long-Term Care (ministry) will be fully automating payments for the St. Joseph’s Health Centre (SJHC) Alternate Funding Plan Agreement (agreement) onto the Ministry Claims Payment System (MCPS).

Changes to Reporting Physician Full-Time Equivalents (FTE)

Commencing February 2018, each physician in the SJHC group will have their FTE recorded and maintained on ministry systems to calculate the monthly Base Rate payment.

FTE physician additions, ends and changes and the effective dates of these changes are required to be reported to the ministry in a timely manner to ensure accurate payments.

Note that the physician affiliation dates are no longer required to begin on the first day of the month and end on the last day of the month.

Changes to the Base Rate Payments

Commencing with the payment for February 2018, the monthly Base Rate payment will be based on the number of days the physician was affiliated to the SJHC group in the current processing month.

FTE physician additions, ends and changes with an effective date in a month earlier than the current processing month will result in a reconciliation of the previous month(s) Base Rate payment.

The current month Base Rate payment and any prior month(s) Base Rate payment reconciliation adjustment(s) will appear on the Group Remittance Advice (RA) as ‘SJHC – St. Joseph’s Health Base Payment’.

Changes to the Payment Deposit Date

The ministry is transitioning away from manually processing the monthly Base Rate payment by direct deposit into the SJHC group bank account on or before the last business day of the month (i.e. Payment for physician FTEs for the month of February are deposited on or before the last day of March).

Commencing with the payment for February 2018, the Base Rate payment and the corresponding discount will be calculated through the MCPS, reported on the SJHC group Remittance Advice (RA) and deposited to the SJHC group bank account on or about the 15th day of the month (i.e. Payment for physician FTEs for the month of February are deposited on or about the 15th day of March).

No Changes to Physician Billing and Claims Submission

Physicians will continue to submit claims for all services provided while working as a SJHC group physician using their four digit B000 group identifier and their physician billing number.

Changes to Monthly Payment Reporting

Changes to SJHC Group RA Reporting

Commencing with the payment for February 2018, the Group RA will now include reporting for the Base Rate payment as follows:

The new Base and Administration Payment Summary Report will report on the Group RA and provide a breakdown by physician and physician FTE with current month and year-to-date totals for the Base Rate payment.   An example of the report is provided as Appendix A.

The Group Payment Report will now include Base Rate physician level reporting with current month and year-to-date totals. An example of the report is provided as Appendix B.

The Group Total – Summary Report will now include reporting of current month and year-to-date totals for the Base Rate payment. An example of the report is provided as Appendix C.

The Discount Summary Report – PHC will now include the total discount amount for the Base Rate payment for each physician for the current month and year to date.  An example of the report is provided as Appendix D.
The new Excluded Services Threshold Report will report on the Group RA and provides an accumulation of billings by physician towards the group’s excluded services ceiling.  An example of the report is provided as Appendix E.

New SJHC Group MCEDT Reporting

Commencing with the payment for February 2018, the group will now receive the OHIP Payment Summary Report.  This report includes physician level reporting of current month and year-to-date totals for the Base Rate payment. An example of the report is provided as Appendix F.

Changes to SJHC Solo RA Reporting

Commencing with the payment for February 2018, each physician in the group will continue to receive their own payment information for each payment element reported on their own solo RA.  The Solo RA will now include reporting for the Base Rate payment as follows:
The Group Total – Summary Report will now include reporting of current month and year-to-date totals for Base Rate payments.  An example of the report is provided as Appendix C.

The Payment Summary Report will now include reporting of current month and year-to-date totals for Base Rate payments.  An example of the report is provided as Appendix G.

For any inquiries regarding automation of the SJHC group payment process please contact the Service Support Contact Centre at:
1-800-262-6524 or SSContactCentre.MOH@ontario.ca

Appendix A

BASE AND ADMINISTRATION PAYMENT SUMMARY REPORT
GROUP-NAME:  SJCH | GROUP-NUMBER: 0B000

BASE

ADMINISTRATION

PRACT#  

FTE

CURR-MTH

YTD

CURR-MTH

YTD

123456

0.80

15,083.43

29,680.30

0.00

0.00

123457

0.70

13,198.00

25,970.26

0.00

0.00

BASE PAY RECOVERY

1,500.00-

1,500.00-

0.00

0.00

TOTAL

1.50

26,781.43

54,150.56

0.00

0.00

Appendix B

GROUP PAYMENT REPORT - PAYMENT ACTIVITY

PHYSICIAN

CURRENT MONTH YTD
123456 15,341.00 31,580.94
123457 13,991.06 25,983.34
SUBTOTAL 29,332.06 57,564.28
GROUP BASE PAYMENT RECOVERY 1,500.00- 1,500.00-
SUBTOTAL 1,500.00- 1,500.00-
TOTAL PAID TO GROUP 27,832.06 56,064.28

Appendix C

GROUP TOTAL - SUMMARY REPORT
GROUP – B000

PHYSICIAN

CURRENT MONTH YTD
TOTAL BLENDED PREMIUMS 1,050.63 1,913.72
BASE PAYMENT 28,281.43 55,650.56
SUBTOTAL 29,332.06 57,564.28
GROUP BASE PAYMENT RECOVERY 1,500.00- 1,500.00-
SUBTOTAL 1,500.00- 1,500.00-
TOTAL PAID TO GROUP 27,832.06 56,064.28

Appendix D

DISCOUNT SUMMARY REPORT - PHC

PROVIDER NUMBER

CURRENT MONTH YTD
123456 26.96- 57.33-
123457 15.49- 21.14-
TOTAL 42.45- 78.47-
DISCOUNT ON ACCESS BONUS 0.00 0.00
DISCOUNT ON ACCESS BONUS RECON 0.00 0.00
DISCOUNT ON BASE PAYMENT RECOVERY 52.45- 0.00
GROUP TOTAL 42.45- 0.00

Appendix E

EXCLUDED SERVICES THRESHOLD REPORT
FISCAL YEAR APRIL 1, 2017 - MARCH 31, 2018
CEILING LEVEL - $406,848.00

 

PAYMENT AMOUNTS PAYMENT
SUBJECT TO CEILING 

PAYMENT
ADJUSTMENTS

CUMULATIVE TOTAL FROM LAST RA

188.25 0.00

PHYSICIAN 012345 CURRENT BILLING CYCLE 0000

4,418.20 0.00

CURRENT BILLING MONTH TOTAL

4,418.20 0.00
NEW CUMULATIVE TOTAL 4,418.20 0.00

Appendix F

OHIP PAYMENT SUMMARY REPORT

TOTAL PAYMENT (A+B):
30,071.36 - 02/15/2018

GROUP PAYMENTS:

  • ST. JOSEPH'S HEALTH BASE PAYMENT
    • CURRENT MONTH:
      -1,500.00

    • YEAR TO DATE:
      -1,500.00

EXCEPTION PAYMENTS:

  • C015 GROUP+ EXCEPTION PAYMENTS TOTAL (A)
    • CURRENT MONTH:
      -1,500.00

    • YEAR TO DATE:
      -1,500.00

GROUP PAYMENTS TO PROVIDER:

  • 123456
    • CURRENT MONTH:
      • BLENDED FEE-FOR-SERVICE PREMIUM 257.57
      • BASE PAYMENT 13,198.00
      • TOTAL CLAIMS PAYABLE 1,461.23
      • AGE PREMIUM PAYMENT 4.06
      • PAYMENT REDUCTION-AUTOMATED PREMIUMS -0.08
      • PAYMENT REDUCTION-OPTED-IN -62.88
      • PAYMENT REDUCTION-PRIMARY CARE -473.69
      • GROUP PAYMENTS TO PROVIDER TOTAL 14,384.21

    • YEAR TO DATE:
      • BLENDED FEE-FOR-SERVICE PREMIUM 1,900.64
      • BASE PAYMENT 25,970.26
      • TOTAL CLAIMS PAYABLE 4,248.05AGE PREMIUM PAYMENT 10.18
      • PAYMENT REDUCTION-AUTOMATED PREMIUMS -0.22
      • PAYMENT REDUCTION-OPTED-IN -185.99
      • PAYMENT REDUCTION-PRIMARY CARE -936.21
      • GROUP PAYMENTS TO PROVIDER TOTAL 31,006.71

GROUP PAYMENTS TO PROVIDER

  • 123457
    • CURRENT MONTH:
      • BLENDED FEE-FOR-SERVICE PREMIUM 793.06
      • BASE PAYMENT 15,083.43
      • TOTAL CLAIMS PAYABLE 2,089.17
      • AGE PREMIUM PAYMENT 5.06
      • PAYMENT REDUCTION-AUTOMATED PREMIUMS -0.58
      • PAYMENT REDUCTION-OPTED-IN -90.89
      • PAYMENT REDUCTION-PRIMARY CARE -692.10
      • GROUP PAYMENTS TO PROVIDER TOTAL 17,187.15

    • YEAR TO DATE:
      • BLENDED FEE-FOR-SERVICE PREMIUM 13.08
      • BASE PAYMENT 37,100.36
      • TOTAL CLAIMS PAYABLE 4,193.31
      • AGE PREMIUM PAYMENT 15.18
      • PAYMENT REDUCTION-AUTOMATED PREMIUMS -1.26
      • PAYMENT REDUCTION-OPTED-IN -182.96
      • PAYMENT REDUCTION-PRIMARY CARE -1,359.39
      • GROUP PAYMENTS TO PROVIDER TOTAL 39,778.32

GROUP PAYMENTS ALL PROVIDERS

  • CURRENT MONTH:
    • BLENDED FEE-FOR-SERVICE PREMIUM 1,050.63
    • BASE PAYMENT 28,281.43
    • TOTAL CLAIMS PAYABLE 3,550.40
    • AGE PREMIUM PAYMENT 9.12
    • PAYMENT REDUCTION-AUTOMATED PREMIUMS -0.66
    • PAYMENT REDUCTION-OPTED-IN -153.77
    • PAYMENT REDUCTION-PRIMARY CARE -1,165.79
    • GROUP PAYMENTS TO PROVIDERS TOTAL (B) 31,571.36

    • YEAR TO DATE:
      • BLENDED FEE-FOR-SERVICE PREMIUM 1,913.72
      • BASE PAYMENT 63,070.62
      • TOTAL CLAIMS PAYABLE 8,441.36
      • AGE PREMIUM PAYMENT 25.36
      • PAYMENT REDUCTION-AUTOMATED PREMIUMS -1.48
      • PAYMENT REDUCTION-OPTED-IN -368.95
      • PAYMENT REDUCTION-PRIMARY CARE -2,295.60
      • GROUP PAYMENTS TO PROVIDERS TOTAL (B) 70,785.03

Appendix G

PAYMENT SUMMARY
REPORT PROVIDER : DR
IDENTIFIER : B000-123456
PHYSICIAN PAYMENT ACTIVITY

PAYMENT DESCRIPTION

CURRENT MONTH 

YTD

BASE PAYMENT

15,083.43 29,680.30

BLENDED FEE-FOR-SERVICE PREMIUM

793.06 1,332.30

PAID TO GROUP

15,876.49 31,012.60
PAID TO PHYSICIAN 0.00 0.00

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