bulletin

Bulletin Number
        4311
Date
        April 17, 1998
Direct inquiries to
         Ministry of Health
         Processing Office

(address below)
Distribution
        Physicians, Hospitals, Clinics, and Laboratories
Subject      CHANGES TO MINISTRY OF HEALTH SCHEDULE OF BENEFITS FOR PHYSICIANS’ SERVICES, EFFECTIVE FEBRUARY 1, 1998 : MAXIMUMS AND UNIT-BASED SERVICES
The attention of physicians is drawn to changes in the Preamble of the Schedule of Benefits,
Part B, Section 11, effective February 1, 1998, that pertain to those services for which payment of a maximum or minimum number services is stipulated and to those services which are billed in terms of time units. Although physicians are encouraged to consult the text of the Schedule itself, the following comments may assist physicians in understanding the changes.

In many cases the Schedule has historically described payment of a service in terms of a minimum or maximum number of services. When the number of services performed of a given type of service is fewer than the specified minimum number of services or more than the specified maximum number of services, those services above or below the respective thresholds remain insured services payable at nil and cannot be billed to the patient. This is not new but is consolidated into the Preamble for the convenience of those reading the Schedule. In effect, a physician must perform the specified minimum number of services in order to receive payment, and any services beyond the specified maximum are considered to be included in the fee paid for the maximum number of services.

When physicians perform services for which time-based "units" are used in submitting claims to OHIP (counselling, psychotherapy, surgical assisting, anaesthesia, etc.), the time at which the service is commenced and is terminated must be recorded in the patient’s medical record. If that information is not recorded, the physician is not entitled to payment of the service. This requirement is new. The General Manager of OHIP has the authority to request copies of medical records at any time for the purpose of monitoring and controlling payment, and all physicians’ records may be subject to further or other review by the Medical Review Committee.

 

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