What is Shadow Billing in Ontario


How does shadow billing work?

Part of my billing is shadow billing. Could you explain to me how to do that? What information about the patient I would need?

What are the three payment programs under OHIP?

To understand shadow billing first we need to know that in Ontario there are three payment programs for doctors:

  1. Fee for service (FFS)
  2. Alternative Payment Plans (APPs), Alternative Payment Agreements (APAs) and Alternative Funding Arrangements (AFPs)
  3. Salary

The vast majority of doctors are paid using the FFS model; however, if you’re going to be working under an alternative payment plan most likely you still need to submit claims to the provincial government. These claims aren't reimbursed for payment but are used for administrative purposes. This is where shadow billing comes into the mix.

We go into more detail about how doctors are paid in our new doctor guide.

How do I do shadow billing?

Most shadow billing is done exactly the same as fee-for-service, except that the funding formula and transaction will be different. ie/ your payment amount would be different although the service codes would be exactly the same. Usually, shadow billers belong to a "group". Best for you to contact the group administrator for details.

Was this article helpful?
0 out of 1 found this helpful