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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: Physician Services

Published by: Negotiations Branch, Ministry of Health

Date Issued: September 4, 2019

Bulletin Number: 4727

Re: Preventative Care Bonus Payment Issue - Resolved

Posted Electronically Only

PDF Version 


Further to INFOBulletin #11212 – Preventive Care Bonus Payments Recovered in Error posted on August 2, 2019, the Ministry of Health (ministry) has resolved the issue.

The ministry processed remedy payments to impacted physicians/groups to offset the Preventive Care Bonus payments recovered in error.  The remedy payments were deposited on or about the 15th of August to coincide with the scheduled August remittance advice (RA) deposit date.

In August 2019, the ministry successfully implemented a correction to the payment system that will result in physicians/groups seeing the following payment/recovery adjustments on the September RA under one of the following scenarios. Please see Appendix A for details regarding the reporting of these adjustments.

  1. Physicians/Groups with a Preventive Care Submission in April to June 2019 only/ No Preventive Care Submission in July or August 2019

  • Physicians/groups will receive payment adjustment equal to the amount of the Preventive Care Bonus payments recovered in error. This payment will appear under the accounting adjustment – Preventive Care Bonus.
  • The ministry will also process a recovery of the remedy payments issued to impacted physicians/groups in August 2019. The remedy payment recovery will appear under the accounting adjustment – 2019 Recovery of Prev Care Remedy Pymt.
  • The September RA will have the Preventive Care Bonus accounting adjustment and show the Payment Summary Report for each physician, which includes Preventive Care Bonus reporting.
  • For groups which receive the Preventive Care Bonus payment as a group payment, the OHIP Payment Summary Report will show the Preventive Care Bonus payment for each physician under their individual Group Payments to Provider section.
  • For groups which receive the Preventive Care Bonus payment as a solo payment, the OHIP Payment Summary Report will show the Preventive Care Bonus payment for each physician under their individual Provider Summary section.
  1. Physicians/Groups with a new Preventive Care Bonus claim submission in July or August 2019

  • Physicians/groups will receive a payment adjustment equal to the amount of the Preventive Care Bonus payments recovered in error PLUS the approved amount of the Preventive Care Bonus claim submitted in August 2019, with the following considerations:
    1. If there was a Preventive Care Bonus claim submitted in July 2019, the payment recovered in error was offset by the payment for that claim on the August RA. The repayment will be for the full value recovered in error without the offset and will appear under the accounting adjustment – Preventive Care Bonus.
    2. If the Preventive Care Bonus claim submitted in August 2019, was for a lower percentage than was previously approved and paid by the ministry, then the payment on the September RA will be net of the adjusted Preventive Care Bonus August claim. This combined payment will appear under the accounting adjustment – Preventive Care Bonus.
  • The ministry will also process a recovery of the remedy payments issued to impacted physicians/groups in August 2019. The remedy payment recovery will appear under the accounting adjustment – 2019 Recovery of Prev Care Remedy Pymt.
  • The September RA will have the Preventive Care Bonus accounting adjustment and show the Payment Summary Report for each physician, which includes Preventive Care Bonus reporting.
  • For groups which receive the Preventive Care Bonus payment as a group payment, the OHIP Payment Summary Report will show the Preventive Care Bonus payment for each physician under their individual Group Payments to Provider section.
  • For groups which receive the Preventive Care Bonus payment as a solo payment, the OHIP Payment Summary Report will show the Preventive Care Bonus payment for each physician under their individual Provider Summary section.
  • For groups which receive the 2019 Recovery of Prev Care Remedy Pymt. adjustment, the OHIP Payment Summary Report will show the recovery under the Exception Payment section.
  1. Physicians/Groups in a negative balance position on the August 2019 RA

  • Physicians/groups that were in a negative balance on the August 2019 RA (excluding the Preventive Care Bonus payment recovery) did not receive a remedy payment.
  • Physicians/groups that were in a negative balance on the August 2019 RA due to the Preventive Care Bonus payment recovery received an advance payment that differed from the amount of the Preventive Care Bonus payment recovered in error. The value of the advance payment was for the full value of what should have been paid on the August 2019 RA.
  • Physicians/groups will receive a payment adjustment equal to the amount of the Preventive Care Bonus payments recovered in error. This payment will appear under the accounting transaction – Preventive Care Bonus.
  • The ministry will also process a recovery of the advance payments issued to impacted physicians/groups in August 2019. The advance payment recovery will appear under the accounting adjustment – Accounting Adjustments.
  • The September RA will have the Preventive Care Bonus accounting adjustment and show the Payment Summary Report for each physician, which includes Preventive Care Bonus reporting.
  • For groups which receive the Preventive Care Bonus payment as a group payment, the OHIP Payment Summary Report will show the Preventive Care Bonus payment for each physician under their individual Group Payments to Provider section.
  • For groups which receive the Preventive Care Bonus payment as a solo payment, the OHIP Payment Summary Report will show the Preventive Care Bonus payment for each physician under their individual Provider Summary section.
  • For groups which receive the “Accounting Adjustments” adjustment, the OHIP Payment Summary Report will show the recovery under the Exception Payment section.
  1. Physicians/Groups with no Preventive Care Bonus payments prior to the August 2019 RA

  • Physicians without a preventive care bonus payment from April to June 2019 were not impacted.
  • Any claim submissions during July were accurately paid and reflected on the August 2019 RA.
  • Your September 2019 RA will correctly reflect any Preventive Care Bonus claim submission processed during the month of August.

The ministry appreciates your patience while we worked to correct this issue. If you have any questions, please contact the Service Support Contact Centre at 1-800-262-6524.


Appendix A – Example Reporting

Preventive Care Bonus payments (Apr – June 2019 RA) with no claims billed in July or August
Scenario: Physician previously claimed the maximum for all bonus categories.

Group Level Payment Group
On the Solo and Group September RA the Preventive Care Bonus Accumulations and Payment report will display the current month payment of $12,800.00 as shown in the chart below.

Image of the Preventive Care Bonus Accumulations and Payment Reporting on the Solo and Group Remittance Advice for Group Level Payment Groups showing the current month payment of $12,800.00

The Group Payments Section of the Group OHIP Payment Summary Report will display the -$12,800.00 recovery of the Remedy Payment in the Exception Payments section of the report as shown in the chart below.

Image of the group payments section of the OHIP Payment Summary Report for group level payment groups reflecting the recovery of the Remedy Payment in the amount of -$12,800.00 under the Exception Payments section of the report.

The Payments to Provider Section of the Group OHIP Payment Summary Report will display the payment of $12,800.00 on the Preventive Care Bonus payment line in the report as shown in the chart below.

Image of the payments to provider section of the OHIP Payment Summary Report for group level payment groups reflecting the payment correction of $12,800.00 on the Preventive Care Bonus payment line of the report.

Solo Level Payment Group
On the Solo and Group September RA the Preventive Care Bonus Accumulations and Payment report will display the current month payment of $12,800.00 as shown in the chart below.

Preventive Care Bonus and Accumulations and Payment report

Image of the Preventive Care Bonus and Accumulations and Payment report  on the Solo and Group Remittance Advice for Solo Level Payment Groups showing the $12,800.00 payment.
The Group Payments Section of the Group OHIP Payment Summary Report will display no impact of the recovery at the group level as shown in the chart below.

Image of the group payments section of the OHIP Payment Summary Report reflecting for solo level payment groups reflecting no impact of the recovery of the Remedy Payment at the group level.
The Payments to Provider Section of the Group OHIP Payment Summary Report will display the -$12,800.00 recovery of the Remedy Payment and the $12,800.00 payment correction on the Preventive Care Bonus payment line in the report as shown in the chart below.

Image of the payments to provider section of the OHIP Payment Summary Report for solo level payment groups reflecting the -$12,800.00 recovery of the Remedy Payment and the $12,800.00 payment correction to the Preventive Care Bonus payments
Preventive Care Bonus Payments (Apr – June 2019 RA) with claims billed in July
Scenario: Physician previously claimed the maximum for all bonus categories except influenza. The physician submitted a Q104A (80% for $2,200.00) claim in July coinciding with the recovery in error.

  • Group Level Payment Group

On the Solo and Group September RA the Preventive Care Bonus Accumulations and Payment report will display the current month payment of $12,800.00 as shown in the chart below.

Image of the Preventive Care Reporting on the Solo and Group Remittance Advice for Group Level Payment Groups showing the current month payment of $10,600.00

The Group Payments Section of the Group OHIP Payment Summary Report will display the -$10,600.00 recovery of the Remedy Payment in the Exception Payments section of the report as shown in the chart below.

Image of the group payments section of the OHIP Payment Summary Report for group level payment groups reflecting the -$10,600.00 recovery of the Remedy Payment under the Exception Payments section on the report.

The Payments to Provider Section of the Group OHIP Payment Summary Report will display the $10,600.00 payment correction on the Preventive Care Bonus payment line in the report as shown in the chart below.

Image of the payments to provider section of the OHIP Payment Summary Report for group level payment groups reflecting the $10,600.00 payment correction to the Preventive Care Bonus payments

Solo Level Payment Group
On the Solo and Group September RA the Preventive Care Bonus Accumulations and Payment report will display the current month payment of $10,600.00 as shown in the chart below.

Image of the Preventive Care Reporting on the Solo and Group Remittance Advice for Solo Level Payment Groups showing the current month payment of $10,600.00

The Group Payments Section of the Group OHIP Payment Summary Report will display no impact of the recovery at the group level as shown in the chart below.

Image of the group payments section of the OHIP Payment Summary Report reflecting for solo level payment groups reflecting no impact of the recovery of the Remedy Payment at the group level.

The Payments to Provider Section of the Group OHIP Payment Summary Report will display the -$10,600.00 recovery of the Remedy Payment and the $10,600.00 payment correction on the Preventive Care Bonus payment line in the report as shown in the chart below.

Image of the payments to provider section of the OHIP Payment Summary Report for solo level payment groups reflecting the -$10,600.00 recovery of the Remedy Payment and the $10,600.00 payment correction to the on the Preventive Care Bonus payment line in the report
Preventive Care Bonus Payments (Apr – June 2019 RA) with claims billed in August
Scenario: A physician previously claimed a Q104A, Q109A, Q114A, Q116A and Q119A. The physician submitted a Q113A (70% for $1,320.00) claim in August after previously billing a Q114A (75% for $2,200.00).

  • Group Level Payment Group

On the Solo and Group September RA the Preventive Care Bonus Accumulations and Payment report will display the current month payment of $7,260.00 as shown in the chart below.

Image of the Preventive Care Reporting on the Solo and Group Remittance Advice For Group Level Payment Groups showing the $7,260.00 current month payment.

The Group Payments Section of the Group OHIP Payment Summary Report will show the -$8,140.00 recovery of the Remedy Payment in the Exception Payments section of the report as shown in the chart below.

Image of the group payments section of the OHIP Payment Summary Report for group level payment groups reflecting the -$8,140.00 recovery of the Remedy Payment under the Exception Payments section of the report.

The Payments to Provider Section of the Group OHIP Payment Summary Report will display the $7,260.00 payment correction on the Preventive Care Bonus payment line in the report as shown in the chart below.

Image of the payments to provider section of the OHIP Payment Summary Report for group level payment groups reflecting the $7,260.00 payment correction to the Preventive Care Bonus payment line on the report.

Solo Level Payment Group
On the Solo and Group September RA the Preventive Care Bonus Accumulations and Payment report will display the current month payment of $7,260.00 as shown in the chart below.

Image of the Preventive Care Reporting on the Solo and Group Remittance Advice for Solo Level Payment Groups showing the current month payment of $7,260.00.

The Group Payments Section of the Group OHIP Payment Summary Report will display no impact of the recovery at the group level as shown in the chart below.

Image of the group payments section of the OHIP Payment Summary Report reflecting for solo level payment groups reflecting no impact of the recovery of the Remedy Payment at the group level.

The Payments to Provider Section of the Group OHIP Payment Summary Report will display the -$8,140.00 recovery of the Remedy Payment and the $7,260.00 payment correction on the Preventive Care Bonus payment line in the report as shown in the chart below.

Image of the payments to provider section of the OHIP Payment Summary Report for solo level payment groups reflecting the -$8,140.00 recovery of the Remedy Payment and the $7,260.00 payment correction to the Preventive Care Bonus payment line on the report.

Groups with a Negative Balance on the August RA due to the Preventive Care Bonus Recovery – No claims in July or August.
Scenario: A physician received the maximum Preventive Care Bonus payment previously. They should have received a payment totalling $7,000.00 on the August RA for other regular claims and primary care payments. However, due to the Preventive Care Bonus payments recovered in error they were put into a negative balance.  The ministry provided an advance payment for the above stated earnings of $7,000.

  • Group Level Payment Group

On the Solo and Group September RA the Preventive Care Bonus Accumulations and Payment report will display the current month payment of $12,800.00 as shown in the chart below.

Image of the Preventive Care Reporting on the Solo and Group Remittance Advice for Group Level Payment Groups showing the current month payment of $12,800.00

The Group Payments Section of the Group OHIP Payment Summary Report will show the -$7,000.00 recovery of the Remedy Payment in the Exception Payments section of the report as shown in the chart below.

Image of the group payments section of the OHIP Payment Summary Report for group level groups reflecting the recovery of the -$7,000.00 Advance Payment under the Exception Payments section of the report.

The Payments to Provider Section of the Group OHIP Payment Summary Report will show the $12,800.00 payment correction on the Preventive Care Bonus payment line in the report as shown in the chart below.

Image of the payments to provider section of the OHIP Payment Summary Report for group level payment groups reflecting the $12,800.00 payment correction to the Preventive Care Bonus payment line on the report.

Solo Level Payment Group
On the Solo and Group September RA the Preventive Care Bonus Accumulations and Payment report will display the current month payment of $12,800.00 as shown in the chart below.

Image of the Preventive Care Reporting on the Solo and Group Remittance Advice for Solo Level Payment Groups showing the current month payment of $12,800.00

The Group Payments Section of the Group OHIP Payment Summary Report will display no impact of the recovery at the group level as shown in the chart below.

Image of the group payments section of the OHIP Payment Summary Report reflecting for solo level payment groups reflecting no impact of the recovery of the Advance Payment at the group level.

The Payments to Provider Section of the Group OHIP Payment Summary Report will show the $12,800.00 payment correction on the Preventive Care Bonus payment line in the report as shown in the chart below.

Image of the payments to provider section of the OHIP Payment Summary Report for solo level payment groups reflecting the -$7,000.00 recovery of the Advance Payment and the $12,800.00 payment correction to the Preventive Care Bonus payment line on the report.

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