Bulletin 221001 — Hospital Technical Fee Medical Claims Adjustment (MADJ)
Payments for technical fees in hospital will be reprocessed by a MADJ
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: October 6, 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.
As per the 2021 Physician Services Agreement and further detailed in INFOBulletin #220803-2021 Physician Services Agreement Year Two Exclusions, hospital technical fees are not eligible for the temporary 2.01% increase. Due to the complexity of the change, these codes were 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 have been paying accurately at the Schedule of Benefits for Physician Services (Schedule) rates.
Claims assessed prior to August 1, 2022, will require reprocessing by a MADJ to pay at the correct rate.
Medical Claims Adjustment (MADJ)
A MADJ is required to reprocess claims for technical services performed in hospital that were assessed between April 1, 2022, and July 31, 2022. These adjusted claims will begin to appear on the October 2022 Remittance Advice (RA).
Fee Schedule Codes (FSCs) being adjusted to the correct rate will appear on the RA with explanatory code ‘55-This deduction is an adjustment on an earlier account’ and ‘80-Technical Fee Adjustment for Hospitals’.
- Please note that during the MADJ process, the claims processing system selects an entire claim for reprocessing.
- A single claim can include multiple FSCs, and all codes will be reprocessed.
- Claims that were reprocessed with no change in payment will appear on the RA with explanatory code ’55-This deduction is an adjustment on an earlier account’ and ’57-This payment is an adjustment on an earlier account’.
- FSCs being adjusted to the correct rate will appear on the RA with explanatory code ’55-This deduction is an adjustment on an earlier account’ and ‘80-Technical Fee Adjustment for Hospitals’.
Physicians, technical fees, Physician Services Agreement, PSA, MADJ, Medical Claims Adjustment, Hospitals