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- Ontario has reached a deal with doctors that saves specialists who treat patients virtually from having their fees slashed, but leaves other physicians out in the cold, The Canadian Press has learned.
- Education and Prevention Committee Billing Briefs
- An Introduction to New OHIP Virtual Care Services and Fee Codes
- New Insured Virtual Care Services Are Effective December 1, 2022
- Definition of Limited and Comprehensive Virtual Care Services
- Establishing An Existing/Ongoing Patient-Physician Relationship
- Maintaining An Existing/Ongoing Patient-Physician Relationship
- Services That Can Be Provided Virtually If Clinically Appropriate
- Location of Patient and Physician When Virtual Care Services Are Performed
- Virtual Care Fee Codes That Pre-Date March 2020 Continue to Be Available For Use
- Examples of Comprehensive and Limited Virtual Care Services
Education and Prevention Committee (EPC) Billing Briefs are prepared jointly by the Ministry of Health (MOH) and the Ontario Medical Association (OMA) to provide general advice and guidance to physicians on billing matters.
Category: All physicians Date of publication: November 24, 2022 Date updated: April 6, 2023 - Updates made to Schedule of Benefits page references
As part of the 2021-2024 Physician Services Agreement, the Ministry of Health (MOH) and the Ontario Medical Association (OMA) agreed to a new virtual care funding framework that adds certain services provided by video and telephone as insured services under OHIP. This new framework replaces the temporary virtual care codes introduced in March 2020....
Limited Virtual Care Servicemeans a Virtual Care Service rendered where no Existing/Ongoing Patient-Physician Relationship exists, and in the physicians’ professional opinion in accordance with accepted professional standards and practice, the person's care and support requirements can be effectively and appropriately delivered by Video or Telephon...
Any of the followingis considered to establish an Existing/Ongoing Patient-Physician Relationship for the purpose of defining which type of virtual care services may be claimed: 1. Where a physician is providing a Virtual Care Service to a patient where there has been at least one insured service with a direct physical encounter between the patient...
Other than for Family Physicians providing virtual services to patients who are enrolled to their primary care practice as defined in #2 above, once an Existing/Ongoing Patient-Physician Relationship has been established, Comprehensive Virtual Care Services are payable for any necessary virtual follow-up care for the next 24-months. Depending on wh...
Please review the College of Physicians and Surgeons of Ontario Virtual Care Policywhich specifies that “virtual care is not appropriate in every instance as not all conditions can be effectively treated virtually and not every patient has access to or will be comfortable using virtual care technology” and that physicians must use professional judg...
Both the patient and physician must be located in Ontario for the services to be insured and payable under OHIP (see section 37.1 of Regulation 552 under the Health Insurance Act).
The new Virtual Care Services are notintended to replace existing Schedule fee codes for services that were eligible for payment if provided virtually prior to March 2020, such as those listed below (please note, this list is not comprehensive). Physicians should continue to claim the most appropriate fee code that describes the insured service pro...
Example 1: Providing virtual primary care to an enrolled patient
On December 1, 2022, Dr. Fisher (a Family Physician) provides a virtual assessment for Ms. Wu (a patient enrolled to Dr. Fisher’s practice which is part of a Family Health Organization) who has booked an appointment to review her response to a new medication for hypertension, including review of her home blood pressure readings. The virtual visit is conducted using a video solution found on Ontario Health’s Verified Solution Listand Dr. Fisher documents the modality of the visit on the patien...
Example 2: Providing virtual care to a patient who does not meet the Schedule criteria for an Existing/Ongoing Patient-Physician Relationship with the physician
Mr. Bass is on holiday at a rented cottage and notices an engorged tick attached to his leg. He is concerned about contracting Lyme disease and wonders if he needs antibiotics to prevent it and has a telephone appointment that day with a Virtual Medical Clinic that he has seen advertised on the subway in his hometown. How should the insured service be claimed by the physician who conducts the telephone assessment and has never previously provided care to Mr. Bass?
Example 3a: Providing a specialist consultation by video
Mr. Verde is referred to a dermatologist by his Family Physician because of an unusual chronic skin eruption. The Dermatology consultation is conducted by Video using a verified video solution. How should this insured service be claimed by the Dermatologist?
Oct 21, 2022 · Ontario has reached a deal with doctors that saves specialists who treat patients virtually from having their fees slashed, but leaves other physicians out in the cold, The Canadian Press has...
Providers with a billing number in the range of 010009 to 333798 and 333800 to 398999 are eligible to submit virtual care claims. Optometrists, podiatrists, and dental surgeons are not eligible to submit claims for physician virtual care services under this new virtual care model.
Effective December 1, 2022, video visits delivered through the Ontario Virtual Care Program (OVCP) will be transitioned into the OHIP insured framework in accordance with the pricing structure, rates, and payment parameters outlined in the PSA. To learn more about how to bill OTN Codes, read our blog here.
Oct 21, 2022 · Additionally, effective December 1, 2022, video visits delivered through the Ontario Virtual Care Program (OVCP) will be transitioned into the OHIP insured framework in accordance with the pricing structure, rates and payment parameters outlined in the PSA.
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The Ontario Virtual Care Program (previously called the Telemedicine Program) amended the program requirements to modernize the province’s approach to virtual care November 15, 2019, by enabling Direct-to-Patient Video Visits and modernizing virtual care compensation 1.
