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Apr 3, 2019 · It's the unintended consequence of the Ontario system that decides how much family doctors are paid. A new study says Ontario's access bonus system — meant to make doctors more available outside ...
Family Health Network (FHN) Model for at least 3 physicians. May replace a retiring or leaving physician anywhere in province. May start or add to existing models in areas of High Physician Need only. See “Joining a FHN or FHO” on p.3 for more details. Blended Capitation Model.
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Other family physicians are compensated through a fee-for-service (FFS) based funding model. This means the family physician bills for each individual service provided during a patient visit – although some FFS models may include additional bonuses and incentives (e.g. Family Health Group). Learn more about family practice compensation models ...
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Jan 4, 2019 · The study published today in the April issue of Health Affairs, showed that the “access bonus,” is being paid more often to family doctors in rural Ontario communities who have healthier patients, who made fewer primary care visits and received less after-hours care. The bonus payment could serve as an incentive for physicians to advise their patients to use emergency departments instead ...
- Introduction
- Capitation Payments
- Base Rate and Comprehensive Care Capitation Payment Reporting
- Base Rate Payment Summary Report
- Comprehensive Care Capitation Payment Summary Report
- Base Rate, Comprehensive Care and Complex Vulnerable Capitation Payment Detail Report
- Base Rate, Comprehensive Care and Complex Vulnerable Capitation Payment Reconciliation Detail Report
- Core Services to Non-Enrolled Patients
- Non-Included Services
- Workplace Safety Insurance Board (WSIB) services
- Services provided to out-of-province patients
- Outside Use
- Special Bonuses and Premiums
- Preventive Care
- Cumulative Preventive Care Bonus Codes
- Tracking and Exclusion Codes
- Remittance Advice Common Explanatory Codes
- I2 – Service is globally funded
- I6 – Premium not applicable
- M1 – Maximum fee allowed for these services has been reached
- Claims Error Report Common Rejection Codes
- A2A – Outside age limit
- AD9 – Not allowed alone
- Q Codes
This guide provides an update on primary care incentives made available to Family Health Organization (FHO) Physicians and replaces the Billing and Payment Information for FHO Signatory Physicians Fact Sheet, May 2007. As a Family Health Organization (FHO) Signatory physician, you may continue to submit claims for services following your current cl...
Your Family Health Organization (FHO) has made the choice to direct their Base Rate and Comprehensive Care Capitation payments to either their monthly solo Remittance Advice (RA) or their monthly group’s RA (solo bank account or group bank account respectively).
The following four capitation reports are provided monthly:
This report provides a demographic breakdown of enrolled patients by age/sex, capitation rate per day in each category, number of member days in the reporting period per category and the total Base Rate Payment amount. The LTC Base Rate Payment amount is included but is not broken down by age/sex. Reported on the monthly RA.
This report provides a demographic breakdown of enrolled patients by age/sex (including LTC patients), CC Capitation rate per day in each category, number of member days in the reporting period per category and the total CC Capitation Payment amount. Reported on the monthly RA.
This paper report provides a complete list of your enrolled patients including the name, health number, age, number of member days in the reporting period per category, and the Base Rate and CC Capitation Payments for each enrolled patient (including LTC).
This paper report provides the effective and end date information of enrolled patients retroactively added or ended from your roster. This report displays financial and neutral transactions that affect a physician’s enrolled patients in the reporting period. For example, a financial transaction could result from retroactive enrolment activity or...
Claims submitted for services included in the Base Rate (i.e. included services) for non-enrolled patients will be paid in accordance with all medical rules and at the appropriate Schedule of Benefits amount.
Claims for services excluded from the Base Rate (i.e. Excluded services) will be paid for all patients (enrolled or non-enrolled) in accordance with all medical rules and at the appropriate Schedule of Benefits amount.
Physicians are eligible to submit and receive payment for services including but not limited to services provided under the Workplace Safety and Insurance Act. A WSIB service must be identified as ‘WCB’ on the claim.
Physicians are eligible to submit and receive payment for services provided to out-of-province patients. The service must be identified as ‘RMB’ on the claim for an out-of-province patient (with the exception of Quebec).
A physician’s Outside Use is equal to the dollar value of included services provided to his/her enrolled patients by a family physician outside the group. Billings of identified GP Focus Practice physicians and physicians delivering services in MOHLTC-designated Urgent Care Clinics will be excluded from Outside Use accumulations. Each physician’s O...
In any fiscal year, physicians are eligible to qualify for all Special Premiums for both enrolled and non-enrolled patients in the following bonus categories: Home Visits, Long-Term Care, Labour and Delivery and Palliative Care. A physician’s Special Premium accumulations and payments are reported monthly on his/her solo RA and the group RA in a...
Eligible FHO physicians may receive Cumulative Preventive Care Payments and bonuses for maintaining specified levels of preventive care to their enrolled patients.
Per fiscal year, bonus payments may be claimed for the five (5) preventive care categories where designated levels of preventive care to specific patient populations are achieved. Physicians will receive an information package including the procedures for claiming the cumulative bonus in April of each year. Bonuses are paid to the FHO on the monthl...
To better assist physicians in monitoring patient status and determining service levels achieved, tracking and exclusion codes are used for identification purposes. When submitted, these codes will identify the patient as having received the preventive care service or identify the patient as having met the criteria for being excluded from the targe...
Note: Claims that are reported on the Remittance Advice have been processed by the MOHLTC. As with Fee-for-Service claims, for any discrepancies please continue to contact the Claims Payment Division of your local MOHLTC Office.
This explanatory code will report on the monthly RA if a claim is submitted for an Included service for an enrolled patient. The claim will pay at zero dollars.
This explanatory code will report on the monthly RA if a Q-code is billed for a patient who is not enrolled in the MOHLTC database on the service date. The assessment code billed along with the Q-code will be paid (subject to all other MOHLTC rules).
This explanatory code will report on the monthly RA when the maximum fee allowed for this service has been reached.
Note: Claims that are reported on the Claims Error Report have been rejected and should be corrected and if eligible, resubmitted for payment. As with Fee-for-Service claims, please continue to contact the Claims Payment Division of your local MOHLTC office for further guidance.
The service has been billed for a patient whose age is outside of the criteria for that service.
Claims are being submitted without a valid assessment code on the same service date.
The following is a complete listing of all Q codes that Family Health Organization (FHO) Signatory physicians are eligible to submit. The conditions for payment of these Q codes have been described throughout the guide.
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Oct 1, 2021 · Outside use and Access Bonus. Effective October 1, 2021, K080, K081, and K082, services rendered on or after October 1, 2021 by a family physician outside of the patient’s enrolling group will be considered Outside Use. The approved amount for these services will be deducted from the enrolling physician’s Access Bonus payment.
People also ask
Could a 'access bonus' benefit family doctors with lower access?
Does Ontario's access bonus system make doctors more available?
How do I pay access bonus payments for enrolled patients?
Who is eligible for the 'access bonus' in Ontario?
What is a family practice compensation model?
Are 'access bonuses' being paid more often in rural Ontario?
Apr 3, 2019 · It's the unintended consequence of the Ontario system that decides how much family doctors are paid. A new study says Ontario's access bonus system — meant to make doctors more available outside of regular hours — is rewarding doctors who are less available. Dr. Rick Glazier is one of the authors of that study into access bonus payments.
