Billing under the Ontario Health Insurance Plan (OHIP) is a crucial process for physicians in Ontario. Accurate and timely billing ensures physicians receive reimbursement for their services while adhering to the province’s regulations. Here, we outline the OHIP billing process, recent updates, and how RexEMR’s RexBill optimizes this system for enhanced efficiency.
1. Patient Encounter and Documentation
The billing process begins with a patient encounter. Physicians document the services provided, including diagnosis codes (ICD-10) and procedure codes listed in the OHIP Schedule of Benefits (SoB). Accurate documentation is essential as it forms the foundation of the billing claim.
2. Claim Preparation
Claim preparation involves compiling all necessary details, including:
- Service and Diagnostic Codes: Selected from the OHIP SoB.
- Referring Physician Information: Inclusion of the referring physician’s six-digit billing or accounting number, when applicable.
- Patient Information: Verification of the patient’s OHIP number, two-digit version code, and date of birth as listed on their health card.
This step ensures that all required data is accurate and complete, reducing the risk of claim rejections.
3. Submission of Claims
Claims are submitted electronically to OHIP through the Medical Claims Electronic Data Transfer (MCEDT) system. With recent advancements like RexBill in RexEMR, file submissions occur automatically on a daily basis, eliminating the need for manual uploads and ensuring timely processing.
4. Adjudication and Timelines
OHIP processes claims to verify their accuracy and eligibility. Key timelines to note include:
- Submission Deadline: Claims must now be submitted within three months (updated in 2023) of the service date.
- Rejection Notifications: Rejected or flagged transactions are generally available within 48 hours of submission, excluding weekends and payment cycle days.
5. Billing Cycle and Payment Dates
OHIP follows a structured billing cycle:
- Billing Cutoff Date: Typically the 18th of each month. If the date falls on a weekend or holiday, it moves to the next working day.
- Payment Date: Payments are made 15 calendar days after the billing cutoff, usually on the 4th or 5th of the following month. Payments are deposited directly into the physician’s account.
6. Reconciliation
Payments come with a Remittance Advice (RA) file detailing approved, adjusted, or rejected claims. The RA file is essential for reconciliation and ensures all services are accurately compensated. RexBill simplifies this process by organizing and presenting RA data efficiently.
How RexBill in RexEMR Enhances OHIP Billing
RexBill, a feature within the RexEMR system, optimizes the OHIP billing process by:
- Daily File Submissions: Automated submissions reduce administrative tasks and ensure no claim misses the deadline.
- Error Reduction: With advanced validation, RexBill maintains a rejection rate of less than 1%, minimizing resubmissions and saving valuable time.
- Superior Reconciliation Tools: RexBill’s integration with RA files allows seamless reconciliation, ensuring accurate and timely tracking of payments.
Benefits of Automation with RexBill
By streamlining the billing process, RexBill frees up significant time for physicians, enabling them to:
- Focus on patient care rather than administrative tasks.
- Increase the number of patients seen, improving clinic efficiency and financial outcomes.
Conclusion
Efficient OHIP billing is vital for the smooth operation of medical practices in Ontario. With innovations like RexEMR’s RexBill, physicians can ensure compliance, reduce administrative burdens, and enhance their practice’s profitability. By automating submissions, minimizing errors, and simplifying reconciliation, RexBill delivers superior service that enables physicians to focus on what matters most: patient care.
