bulletin

Bulletin Number
        4320
Date
        October 19, 1998
Direct inquiries to

         Ministry of Health
         Processing Office


(address below)
Distribution  
Physicians, Hospitals, Clinics, and Laboratories
Subject      UTILIZATION MANAGEMENT: THRESHOLD FEE REDUCTIONS

1. New Appendix E
2. Technical Fee Reduction
3. Text of Appendix E

1. New Appendix E
Appendix E to the Preamble to the physicians’ Schedule of Benefits (SOB) is amended effective April 1, 1998, as announced in Bulletin 4309, April 9, 1998.

Appendix E is re-titled "Physician Fee Codes excluded from threshold calculation of "Total Amount Payable" to more accurately describe its function. (The "Total Amount Payable" is the amount which triggers threshold reductions.)

2. Technical Fee Reduction
As also announced in Bulletin 4309, technical fees will also be subject to the first level of threshold reductions. The "Total Amount Payable" for the purpose of threshold calculations is comprised of codes not listed in Appendix E. When the "Total Amount Payable" reaches or exceeds the first threshold level, associated technical payments will be reduced by one-third. The technical fee reduction will remain at one-third even if the "Total Amount Payable" for other fees passes subsequent threshold levels.

The system has not yet been upgraded and adjustments may be applied on a manual basis. Individuals effected will be notified.

3. Text of Appendix E
Attached is Amendment List Number 3 to the Schedule of Benefits containing the updated Appendix E dated August 10, 1998.

The complete Schedule of Benefits-Physician Services and the Ministry of Health Bulletins are available on the Ministry's web site www.health.gov.on.ca.

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