The only exception is Emergency Sessional Fees (fee codes H400 to H408) which will continue to be excluded from thresholds. In addition, Miscellaneous Therapeutic Procedures (fee code G467) has been removed from the list of excluded fees. A detailed listing of the codes that will not longer be excluded, as well as, a list of the fee codes that will continue to excluded from thresholds is contained in Sections B and C of this bulletin. This change will be reflected in the billing information provided on your May remittance advice.

Effective Date: April 1, 1998

b) Technical Fees subject to threshold

Only professional fees will be used to determine the level of threshold reduction, and the rate of threshold reduction will be applied to both the professional and technical fees. For example, if a physician’s professional fee billings reach the first threshold ($300,000 for General Practitioners; $380,000 for Specialists), associated technical payments will be adjusted at the same rate as the professional payment. Details will be provided in a later bulletin. The Ministry will have the systems changes ready by July 1, 1998 but it will not be needed until physicians begin reaching threshold later in the fiscal year.

Effective Date: System ready by July 1, 1998; will be effective when physicians reach threshold

2. Technical Fees and Facility Fees

a) Technical Fees for Diagnostic Services in Hospitals

Technical Fee billings to OHIP for diagnostic services provided in hospitals have increased by more than 12% for fiscal year 1997/98. Technical fees will be limited to 1.5% growth for fiscal years 1998/99 and 1999/2000, the same growth rate agreed to for the overall authorized fee-for-service budget. A variety of options are being considered and will be reviewed with the Ontario Hospital Association. Details will be provided in a future bulletin.

Effective Date: Systems changes will be implemented as necessary for fiscal year 1998/99

b) Facility Fees for Independent Health Facilities (IHF’s)

Facility Fee billings by IHF’s to the OHIP fee-for-service budget are also growing in excess of the 1.5% provided for in the Physician Service Agreement. Facility fees paid to IHF’s will also be subject to payment controls, which have yet to be finalized. A volume discount is being considered.

c) Other Technical Fee Control Measures

The Ministry is looking at ways to improve compliance with the Schedule of Benefits with respect to hospital billings to OHIP for technical fees. Diagnostic services for in-patients including emergency room patients are paid for through the hospital operating budgets and are not to be billed to OHIP. A bulletin will follow clarifying previously issued Ministry bulletins on the same subject.

3. Schedule of Benefits Changes

The following changes have been recommended and agreed to by the PSC:

a) Limit of two ultrasounds per normal pregnancy, one of which is a complete ultrasound.
b) Sleep study clinics must be licenced as an Independent Health Facility if not operating in a hospital.
c) Special visit premiums for additional patient seen will be removed from the Schedule of Benefits, with the exception of K codes (ER) and C codes (in-patient).
d) Full payment of resuscitation fees will be limited to a maximum of three physicians.
e) Attendance at delivery can be billed only if the physician attends the labour.
f) Payment one pap test per year unless results are other than normal, in addition to pap smears included in consultations or assessments.
g) Immunizations for travel will not be billable to OHIP. They are available through public health units.
h) Physicians will be paid only the P2 fee for self-referred diagnostic tests.
i) The technical fees associated with colour doppler will be removed from the Schedule of Benefits.

A bulletin and amendments to the Physician Schedule of Benefits will be mailed out in June 1998.

Effective Date: Changes are to be effective July 1, 1998

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