| In an
ongoing effort to implement the
government’s "zero
tolerance" strategy for health care
fraud and streamline the claims payment
process, the Ministry will be shortly
ending the "good faith" claims
payment policy. This measure, announced
by the Minister in September, will place
responsibility on the card holder to have
a valid card and to carry it at all
times. The Ministry will no longer pay
for services rendered when the
eligibility of the card holder has ended,
or for services rendered in a hospital
setting when the health number has a
missing or incorrect version code. To
that end, public advertising will
highlight the need for Ontarians to share
responsibility for maintaining the
integrity of their health cards and,
ultimately, the province’s health
system. While this measure was
originally to be introduced on January 1,
1998, changes to the legislation which
will effectively eliminate "good
faith" payments will come into
effect March 1, 1998. The Ministry has
delayed the implementation of this policy
for a short period of time to allow for
appropriate communication to the public
and providers. Effective March 1, 1998,
the Ministry will no longer pay for
services rendered when eligibility has
ended, or when the health number has a
missing or incorrect version code.
This
change to the "good faith"
payment policy has been made possible
with the establishment of three automated
validation mechanisms available to
providers starting in 1994. At that time,
all health care providers were invited to
take advantage of the first, Interactive
Voice Response (IVR), which makes use of
common touch tone telephone technology.
Magnetic stripe swipe Health Card Readers
(HCRs) were also made available to
hospitals in 1994 and large groups in
1995. Overnight Batch Eligibility
Checking (OBEC) is currently being
piloted to pre-validate those with
scheduled appointments. At present, over
17,000 health care providers and
facilities have access to the
Ministry’s validation systems with
at least one type of validation service
available to each provider.
Providers
who are not now registered to use one of
the validation systems may contact the
Ministry of Health Validation Help Desk
at 1-800-262-6524 or in Kingston at
548-7981 for details or assistance.
All providers have the
ability to take the necessary steps to
verify the validity of health cards
presented or used in billing the Ministry
before claims are submitted; therefore,
the Ministry is actioning the following
two initiatives:
Revoke Regulation
552, section 4 under the HIA
Regulation 552 will be
amended to revoke section 4 of
the Regulation. The original
intent of this section, to honour
claims where premium
based/coverage problems existed
for the eight digit OHIP number
which the health care provider
could not know at the time the
service was rendered, is no
longer relevant.
Discontinue
payment of claims for
hospital-based services when the
health number version code is
missing or incorrect for the date
of service
As a result of the 1993
MOH/OMA Agreement, the Ministry
was required to pay claims in
good faith for hospital-based
services when the version code
was missing or incorrect for the
date of service. In 1996 the
Agreement was revoked, but the
Ministry continued to pay this
type of claim in good faith.
Since all hospitals can access
validation systems or could have
the patient complete a Health
Number Release form, this
practice is unnecessary.
As is the
case now, the Ministry wants to ensure
that emergency health services continue
to be provided to persons in need. We do
recognize that physicians providing
services in an emergency department
environment may have difficulty in
acquiring the correct health number and
version code for the patient for billing
purposes. The Ministry will provide
additional assistance to staff or
physicians in an emergency department, so
that the release of this information
using a Health Number Release form will
be accelerated when an invalid validation
response has been received.
Enquiries
or requests for clarification regarding
the elimination of "good faith"
payments can be made to your local
Ministry of Health - OHIP office.
REIMBURSEMENT
FOR MALPRACTICE FEES - 1997 PROGRAM
(Physicians only)
Applications
for the 1997 Malpractice Reimbursement
Program will be mailed to all eligible
Ontario physicians on or about January
15, 1998. The application packages will
be forwarded by the CMPA; it will include
a covering letter, an application form,
eligibility requirements, 1997 CMPA fee
schedule, your CMPA acknowledgment and a
return envelope. Application packages
will be mailed directly from the Ministry
of Health for those physicians not
ensured with the CMPA.
Physicians
are reminded that the CMPA acknowledgment
is required in their submission to the
Ministry for reimbursement.
Physicians’ insured with other
insuring agents must submit a receipt
reflecting full payment of premiums.
Applications
must be completed and forwarded to the
Ministry by June 30th, 1998 at:
Ministry of Health
Reimbursement of Malpractice Fees
P.O. Box 48
Kingston ON K7L 5J3
Enquiries
regarding reimbursement of malpractice
fees should be directed to your local
Ministry of Health - OHIP office.
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