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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: Toronto Palliative Care Associates Physicians

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

Date Issued: February 21, 2018

Bulletin Number: 11188

Re: Automation of Base Rate, Administrative and After-Hours On-Call Payments

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 Toronto Palliative Care Associates (TPCA) 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 TPCA group will have their FTE recorded and maintained on ministry systems to calculate the monthly Base Rate, Administrative and After-Hours On-Call payments.

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 and Administrative Payments

Commencing with the payment for February 2018, the monthly Base Rate and Administrative payments will be based on the number of days the physician was affiliated to the TPCA 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 and Administrative payments.

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 ‘TPCB – Toronto Palliative Base Payment’.

The TPCA group is eligible for FTE based physician Administrative Payments plus an additional 1.0 FTE group Administrative payment.  Together these Administrative payments will appear on the Group RA as – ‘TPCA –Toronto Palliative Admin Payment’.

The ‘TPCA –Toronto Palliative Admin Payment’ will also include any prior month(s) Administrative payment reconciliation adjustment(s) as a result of changes to the physician FTE value.

Changes to the After-Hours On-Call Payment

Commencing with the payment for February 2018, the 1.2 FTE based After-Hours On-Call payment will be based on the number of days in the current processing month.

The After-Hours On-Call payment will appear on the Group RA as – ‘TPAH – Toronto Palliative After-Hours Payment’.

Changes to the Payment Deposit Date

The ministry is transitioning away from manually processing the monthly Base Rate, Administrative and After-Hours On-Call payments by direct deposit into the TPCA 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, Administrative and After-Hours On-Call payments and the corresponding discounts will be calculated through the MCPS, reported on the TPCA group Remittance Advice (RA) and deposited to the TPCA 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 TPCA group physician using their four digit C015 group identifier and their physician billing number.

Changes to Monthly Payment Reporting

Changes to TPCA Group RA Reporting

Commencing with the payment for February 2018, the Group RA will now include reporting for the Base Rate, Administrative and After-Hours On-Call payments 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 Base Rate and Administrative payments.   Current month and year-to-date group level reporting is also included for Group Administrative and After-Hours On-Call payments.  An example of the report is provided as Appendix A.

The Group Payment Report will now include Base Rate and Administrative physician level reporting with current month and year-to-date totals, as well as group level reporting for Group Administrative and After-Hours On-Call payments.  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 Base Rate, Administrative, Group Administrative and After-Hours On-Call payments.  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.  The report will also show the total discount for the Group After-Hours On-Call monthly payment.  An example of the report is provided as Appendix D.

New TPCA Group MCEDT Reporting

Commencing with the payment for February 2018, the TPCA group will now receive the OHIP Payment Summary Report.  This report will include physician level reporting of current month and year-to-date totals for Base Rate, Administrative, Group Administrative and After-Hours On-Call payments.  An example of the report is provided as Appendix E.

Changes to TPCA 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, Administrative and After-Hours On-Call payments as follows:

The Group Total – Summary Report will now include reporting of current month and year-to-date totals for Base Rate, Physician Administrative, Group Administrative and After-Hours On-Call 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 and Physician Administrative payments.  An example of the report is provided as Appendix F.

For any inquiries regarding automation of the TPCA 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:  TPCA | GROUP-NUMBER: 0C015

BASE

ADMINISTRATION

PRACT#  

FTE

CURR-MTH

YTD

CURR-MTH

YTD

123456

0.80

15,083.43

29,680.30

2,038.36

4,010.96

123457

0.70

13,198.00

25,970.26

1,783.56

3,509.59

 AFTERHOURS ONCALL 22,625.00 45,250.00 0.00 0.00
GROUP ADMIN 0.00 0.00 2,500.00 5,000.00

BASE PAY RECOVERY

1,500.00-

1,500.00-

0.00

0.00

TOTAL

1.50

49,406.43

90,400.56

6,321.92

12,520.55

Appendix B

GROUP PAYMENT REPORT - PAYMENT ACTIVITY

PHYSICIAN

CURRENT MONTH YTD
123456 17,914.85 35,023.56
123457 15,239.13 30,048.19
SUBTOTAL 33,153.98 65,071.75

GROUP - AFTER HOURS ON CALL COVERAGE PYMT

22,625.00 45,250.00
GROUP ADMINISTRATIVE PAYMENT 2,500.00 5,000.00
GROUP BASE PAYMENT RECOVERY 1,500.00- 1,500.00-
SUBTOTAL 23,625.00 48,750.00
TOTAL PAID TO GROUP 56,778.98 113,821.75

Appendix C

GROUP TOTAL - SUMMARY REPORT
GROUP – C015

PHYSICIAN

CURRENT MONTH YTD
TOTAL BLENDED PREMIUMS 1,050.63

1,900.64

BASE PAYMENT 28,281.43 55,650.56
PHYSICIAN ADMINISTRATIVE PAYMENT 3,821.92 7,520.55
SUBTOTAL 33,153.98 65,071.75

GROUP - AFTER HOURS ON CALL COVERAGE PYMT

22,625.00 45,250.00
GROUP ADMINISTRATIVE PAYMENT 2,500.00 5,000.00
GROUP BASE PAYMENT RECOVERY 1,500.00- 1,500.00-
SUBTOTAL 23,625.00 48,750.00
TOTAL PAID TO GROUP 56,778.98 113,821.75

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 AFTER HOURS ON CALL 10.00- 0.00
DISCOUNT ON BASE PAYMENT RECOVERY 5.00- 0.00
GROUP TOTAL 52.45- 0.00

Appendix E

OHIP PAYMENT SUMMARY REPORT

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

GROUP PAYMENTS:

  • GROUP ADMINISTRATIVE PAYMENT
    • CURRENT MONTH:
      2,500.00

    • YEAR TO DATE:
      5,000.00

  • AFTER HOURS ON CALL PAYMENT
    • CURRENT MONTH:
      22,625.00

    • YEAR TO DATE:
      45,250.00

  • FFS CORE SERVICES CEILING PAYMENT ADJ
    • CURRENT MONTH:
      0

    • YEAR TO DATE:
      0

  • TPCA BASE PAYMENT
    • CURRENT MONTH:
      -1,500.00
    • YEAR TO DATE:
      -1,500.00

EXCEPTION PAYMENTS:

  • C015 GROUP+ EXCEPTION PAYMENTS TOTAL (A)
    • CURRENT MONTH:
      25,125.00
    • YEAR TO DATE:
      50,250.00

GROUP PAYMENTS TO PROVIDER:

  • 123456
    • CURRENT MONTH:
      • BLENDED FEE-FOR-SERVICE PREMIUM 257.57
      • BASE PAYMENT 13,198.00
      • PHYSICIANS ADMINISTRATIVE PAYMENT 1,783.56
      • 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 16,167.77

    • YEAR TO DATE:
      • BLENDED FEE-FOR-SERVICE PREMIUM 1,900.64
      • BASE PAYMENT 25,970.26
      • PHYSICIANS ADMINISTRATIVE PAYMENT 3,509.59
      • TOTAL CLAIMS PAYABLE 4,248.05
      • AGE 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 34,516.30

GROUP PAYMENTS TO PROVIDER

  • 123457
    • CURRENT MONTH:
      • BLENDED FEE-FOR-SERVICE PREMIUM 793.06
      • BASE PAYMENT 15,083.43
      • PHYSICIANS ADMINISTRATIVE PAYMENT 2,038.36
      • 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 19,225.51

    • YEAR TO DATE:
      • BLENDED FEE-FOR-SERVICE PREMIUM 13.08
      • BASE PAYMENT 37,100.36
      • PHYSICIANS ADMINISTRATIVE PAYMENT 5,031.70
      • 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 44,792.02

GROUP PAYMENTS ALL PROVIDERS

  • CURRENT MONTH:
    • BLENDED FEE-FOR-SERVICE PREMIUM 1,050.63
    • BASE PAYMENT 28,281.43
    • PHYSICIANS ADMINISTRATIVE PAYMENT 3,821.92
    • 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) 35,393.28

    • YEAR TO DATE:
      • BLENDED FEE-FOR-SERVICE PREMIUM 1,913.72
      • BASE PAYMENT 63,070.62
      • PHYSICIANS ADMINISTRATIVE PAYMENT 8,523.29
      • 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) 79,308.32

Appendix F

PAYMENT SUMMARY
REPORT PROVIDER : DR
IDENTIFIER : C015-123456
PHYSICIAN PAYMENT ACTIVITY

PAYMENT DESCRIPTION

CURRENT MONTH 

YTD

BASE PAYMENT

15,083.43 29,680.30

ADMIN PAYMENT

2,038.36 4,010.96
BLENDED FEE-FOR-SERVICE PREMIUM 793.06 1,332.30

PAID TO GROUP

17,914.85 35,023.56
PAID TO PHYSICIAN 0.00 0.00

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