Ontario Health Insurance Plan

INFOBulletin

Temporary increases for physician services payments

The ministry will temporarily increase physician payments by 2.01% for the period April 1, 2022 to March 31, 2023.


To: All Physicians and Hospitals
Category: Physician Services
Written by: Claims Services Branch; OHIP, Pharmaceuticals and Devices Division
Date issued: April 1, 2022
Bulletin Number: 220402


Physician Services Agreement Initiatives Effective April 1, 2022

The Ministry of Health and the Ontario Medical Association have been working together to implement physician compensation increases in accordance with the 2021 Physician Services Agreement.

Year 2 (2022-2023) of the Agreement provides for a lump sum payment that will be applied as a temporary 2.01% global increase to the value of Fee Schedule Codes (FSCs) for physician services rendered between April 1, 2022 and March 31, 2023. This will be achieved through an update to the Fee Schedule Master (FSM).

Shadow Billing

Physician contract payments which are tied to the OHIP claims system through shadow billing will receive the temporary 2.01% increase.

Premium and add-on Fee Schedule Codes

Premium and add-on FSCs that pay a percent increase have not been changed but will calculate the premium payments using the increased fee approved value of the accompanying eligible service(s).

More information regarding K083

Please note, while the value of K083 has increased to $5.10, physicians may continue to calculate the number of units as outlined in previous INFOBulletins but claim $5.10 per unit. To achieve the temporary 2.01% increase on services claimed using K083, physicians should use the value of the FSC listed in the Schedule of Benefits for Physician Services to determine the number of units to claim.

See previous INFOBulletins for more information regarding K083.

For example, as per the bulletins above, an internal medicine physician providing the service of A133 Medical Specific Assessment with a Schedule listed price of $79.85 by video/telephone prior to April 1, 2022 would bill 16 units of K083 at $5 per unit ($80).

A physician providing the service of A133 by video/telephone after April 1, 2022 would bill 16 units of K083 at $5.10 per unit ($81.60) to receive the 2.01% increase.

The increase is paid as a unit price change, therefore the number of units billed before and after April 1, 2022 should remain the same.

Community Palliative Care On-Call

The temporary 2.01% increase has also been applied to the Community Palliative Care On-Call (CPOC) FSC (B400) submitted through the OHIP claims system for services rendered between April 1, 2022 and March 31, 2023.

Tables showing Fee Schedule Code increases

Tables showing the applicable FSC increases are available with this INFOBulletin.

Update your billing software

Please ensure that your billing software is updated to reflect the new FSC values for any services rendered on or after April 1, 2022, before submitting your claims.

The updated Fee Schedule Master can be found on the Ministry of Health website. This file will be available for download by April 7, 2022.
Claims processed through the OHIP claims system with a service date between April 1, 2022 and March 31, 2023 will reflect these increases and will be reported on your Remittance Advice.

Technical Fees

All technical services will be eligible for the temporary increase of 2.01% except for technical services performed in hospital.

Technical services are defined by Fee Schedule Codes with a B suffix for Diagnostic Radiology, Diagnostic Ultrasound, Nuclear Medicine-In Vivo, Pulmonary Function Studies, Sleep Studies and for Diagnostic and Therapeutic Technical Procedures with any suffix.

Technical services performed in hospital must be billed with a Service Location Indicator of HED (hospital emergency department), HOP (hospital out patient), HDS (hospital day surgery), HRP (hospital referred patient), or HIP (hospital in-patient).

Eligible technical services performed in office and facility fees paid to Independent Health Facilities will receive the temporary 2.01% increase effective April 1, 2022 through to March 31, 2023.

Due to staged implementations, Medical Claims Adjustments (MADJ) may be required to reprocess and adjust hospital technical service claims to the eligible rate.

Further information will be provided in advance of a MADJ.

Reciprocal Medical Billing (RMB)

Payments made through the RMB payment program, and any associated premiums, are not eligible for the 2.01% increase.

Due to staged implementations, a MADJ may be required to reprocess and adjust RMB claims to the eligible rate.

Further information will be provided in advance of a MADJ.

Alternative Payment Programs

The ministry is working with the OMA to flow lump sum payments to non-fee for service funding models and will provide an update on timing of payments by the end of April 2022.

Keywords/Tags

FSM; payments; technical fees; physicians; Physician Services Agreement; PSA; fee schedule master;

Contact Information

Do you have questions about this INFOBulletin? Email the Service Support Contact Centre or call 1-800-262-6524.

For More Information

Call ServiceOntario, Infoline at:
1–866–532–3161 (Toll–free)
In Toronto, (416) 314–5518
TTY 1–800–387–5559.
In Toronto, TTY (416)327–4282
Hours of operation: Monday to Friday, 8:30am – 5:00pm

 
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