Bulletin 220803 — 2021 Physician Services Agreement Year Two Exclusions
A system change has been implemented to adjust claims for technical services performed in hospital.
To: All Physicians, Primary Care Physicians and Hospitals
Category: Physician Services; Primary Health Care Services
Written by: Claims Services Branch; OHIP, Pharmaceuticals and Devices Division
Date issued: August 23, 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.
As per INFOBulletin #220401-Temporary Increases for Physician Services Payments, Year 2 (2022-2023) of the Agreement provided 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.
Hospital technical fees are not eligible for the temporary 2.01% increase. Due to the complexity of the change, these codes have been receiving the increased value until a system change could be implemented.
Effective August 1, 2022, technical fees in hospital with a service date on or after April 1, 2022, processed through the OHIP claims system will pay at the Schedule of Benefits for Physician Services (Schedule) rates.
A Medical Claims Adjustment (MADJ) will be required to reprocess claims for technical services performed in hospital that were assessed between April 1, 2022, and July 31, 2022.
Further information will follow in advance of the Medical Claims Adjustment.
Technical services performed in hospital
- Technical services performed in hospital should be billed at the Schedule rates.
- Technical services performed in hospital are defined as FSCs with a B suffix for Diagnostic Radiology, Diagnostic Ultrasound, Nuclear Medicine-In Vivo, Pulmonary Function Studies, Sleep Studies; and Diagnostic and Therapeutic Technical Procedures with any suffix, billed with any of the following Service Location Indicators (SLI):
- HED (hospital emergency department)
- HOP (hospital out patient)
- HDS (hospital day surgery)
- HRP (hospital referred patient)
- Note that technical fees are not payable for inpatients (SLI of HIP-hospital in-patient).
- FSCs being adjusted to the correct rate will appear on the Remittance Advice with explanatory code ‘80-Technical Fee Adjustment for Hospitals’.
- The Schedule of Benefits for Physician Services can be found on the Ministry of Health website.
Reciprocal Medical Billing (RMB) services
The following is a correction to previously published INFOBulletin #220401-Temporary Increases for Physician Services Payments: Payments made through the RMB payment program are now eligible for the 2.01% increase with the exception of technical services performed in hospital.
Keywords/tags
Fee Schedule Master; FSM; physicians; technical services; RMBS; Reciprocal Medical Billing; Physician Services Agreement; PSA
Contact information
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