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Mar 16, 2023 · “Canadians pay for their health-care services through their tax dollars, and should not be asked to pay again by way of patient charges when they need to access those services,” the...
- Introduction of The New Virtual Care Model in The Ontario Health Care System
- Virtual Care - Background and Resources
- Covid-19 Virtual Care K-Codes
- Modality Indicators
- Eligible Providers and Payment Programs
- Patient-Physician Relationship
- Comprehensive Virtual Care Services
- Primary Care
- Premiums, Management Fees, and Special Premiums
- Additional Information For Claim Submission and Payment of Virtual Care Services
To: All physicians Category: Physician Services; Primary Health Care Services Written by: Negotiations Branch, Physician and Provider Services Division Date issued: December 22, 2022
The Ministry of Health (ministry) and the Ontario Medical Association (OMA) have been working together to implement the 2021 Physician Services Agreement (PSA). Effective December 1, 2022, the Schedule of Benefits (the Schedule) has been amended to reflect the new virtual care funding framework, as set out in the PSA and communicated in INFOBulleti...
The existing K080A-K083A and K092A-K095A virtual care K-codes will be ended on November 30, 2022. Claims submitted with a service date of December 1, 2022, or later will reject to the provider’s error report with error code ‘A3E - No Such F.S Code’.
Effective December 1, 2022, physicians will continue to use the K300A (Video) or K301A (Telephone) modality indicators to identify the technology used to deliver the service when claiming comprehensive virtual care services. These fee codes must be submitted on the same claim using the same service date as the eligible insured virtual service. If a...
Virtual services can be claimed for the eligible insured services listed in Appendix J of the Schedule and can be provided under payment programs Health Claims Payment (HCP) and Workplace Safety and Insurance Board (WCB). Providers with a billing number in the range of 010009 to 333798 and 333800 to 398999 are eligible to submit virtual care claims...
To submit comprehensive virtual care services for payment under the new virtual care payment structure, physicians must establish a patient-physician relationship prior to submitting applicable Fee Schedule Codes (FSCs). The definition and criteria of a patient-physician relationship can be found in the Schedule under the Virtual Care Services sect...
Comprehensive virtual care services are video and/or telephone services insured and payable under existing or new FSCs listed in Appendix J, Section 1of the Schedule. Appendix J also indicates the eligible modality for each service. Comprehensive virtual care services must be rendered in the context of an existing/ongoing patient-physician relation...
Included/core services
The new virtual care FSCs A010A, A011A, A814A, A817A, A818A, A906A, A913A, A914A, A101A, and A102A have been added as included/core services for all primary care models. Approved claims for enrolled patients will be paid at $0.00 with an I2 explanatory code and compensated at the shadow billing rate where appropriate for each model. Family Health Group (FHG) and Comprehensive Care Model (CCM) physicians will be paid Fee-For-Service (FFS). If a provider’s affiliation or a patient enrolment sta...
Outside use
Primary care core services provided virtually, where eligible, will contribute to outside use for the enrolling physician when provided to an enrolled patient by a general practitioner outside of the patient’s group at the rate paid for the virtual service. GP Focused Practice Physicians providing virtual care services to enrolled patients will continue to be exempt from contributing to the enrolling physicians’ Outside Use, where eligible. The new A010A, A011A, A906A, A913A, and A914A GP Foc...
After-hours
Primary care after-hours services provided virtually, where eligible, will continue to be payable using the existing after-hours premium or tracking codes. This includes: 1. Q012A for FHG, Family Health Network (FHN), Family Health Organization (FHO), Group Health Centre (GHC), Blended Salary Model (BSM), Rural and Northern Physicians Group Agreement (RNPGA), St. Joseph's Health Centre (SJHC), Weeneebayko Area Health Authority (WAHA) physicians 2. Q016A for CCMphysicians 3. Q017A for GP Focus...
Premiums
In addition to the primary care after-hours premiums identified above, the premiums and management fees eligible under virtual care are identified in the Schedule under the heading Virtual Care Services - Premium and Management Fees as well as in Appendix Q. These premiums are payable when providing eligible comprehensive virtual care services and when the necessary Schedule requirements have been met. Where premiums require an accompanying/qualifying comprehensive virtual care service to be...
Management fees
Eligible comprehensive virtual care services will contribute to eligible management fees listed in the Virtual Care Services section of the Schedule, with the following additional criteria: 1. A virtual ‘K030A - Diabetic management assessment’ service is only payable if an in-person K030A has been billed in the preceding 12 months by the same physician. 1. If an in-person K030A is not found in the preceding 12 months, the virtual K030A will be approved at $0.00 with new explanatory code ‘B8 -...
Special premiums
Where existing requirements are met, eligible comprehensive virtual care services and FSCsidentified in Appendix J, Section 1 and Appendix Q of the Schedule billed virtually will contribute to eligible Special Premiums as follows: 1. Q020A and Q021A billed with a modality indicator will contribute to the Primary Care-Serious Mental Illness (PC-SMI) Special Premium 2. C010A billed with a modality indicator will contribute to the Hospital Special Premium
All existing payment rules and restrictions for the services listed in Appendix J of the Schedule will apply to claims with services submitted with a virtual care modality indicator. A full listing of new error and explanatory codes can be found in Appendix A of this INFOBulletin.
1 day ago · Health workers across Canada, including doctors and nurses, say patients can wait no longer to know whether paying out-of-pocket for medically necessary care is allowed when delivered virtually or ...
Mar 18, 2023 · In Ontario, patients are promoted to pay $55 for a single live chat and healthcare packages range from $50 to $107 a month for continued services.
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...
Dec 2, 2022 · A virtual care platform connecting patients with doctors in Ontario has cut back on services and seen a mass exodus of physicians after changes to fees for virtual appointments kicked in this...
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Mar 17, 2023 · Amid a growing shortage of family doctors and increasing pressure on Canada’s hospital systems, recent funding changes have slashed access to virtual care in Ontario — forcing some patients to choose between a potentially unnecessary emergency room visit and paying out of pocket for care that used to be free, according to the founder of one ...
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Access doctors online in as soon as 15 minutes for medical consultations and rx. Act now! Around-the-clock urgent health care. Consult with a doctor and get treatment fast.
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