OHIP Billing Tip #20 - Custom Facilities - Clinic and Outpatient Segmentation


How to manage your OHIP income by facility or location

We have created a feature to segment your billings by different outpatient locations. 


When billing under an outpatient setting, OHIP requires the facility field to be empty ("No Facility/Outpatient Clinic"). This creates an issue when you are trying to segment patients by different outpatient locations. 

Use case:

You have a practice with three locations:

  • Locum at a family practice (you need to pay overhead based on the revenue that you bill)
  • Private nursing home
  • Hospitalist

For the My Patient List feature, you need to create two different outpatient lists. One for the locum at the family practice, and also for the private nursing home.

In addition, you need to pay overhead to the clinic based on the patients you bill there. 


Step 1 - Create a custom facility for the family practice and the nursing home

Top right gear icon --> Settings --> My Custom Facilities

Create a custom facility

Step 2 - When creating a claim, choose the facility based on your location:

  • Locum at a family practice = Custom Facility - GTA Health
  • Private nursing home (ie/ a facility not identified by OHIP) = Custom Facility - Nursing Home
  • Hospitalist = 4005 - Lakeridge Health (AT) 

Create a new claim with custom facility

Step 3 - Create your outpatient list using the GTA Health and Nursing Home facilities

Segment outpatients by facility for OHI

Step 4 - Run a report and filter by a facility

Advanced Reports --> Claim Summary Payment --> Facility --> Custom - GTA Health

Advanced financial reports by medical fa

If you like to create a report for all your No Facility / Outpatient Clinics, you can leave the "Facility" filter empty.

Accounting Transactions:

Keep in mind that MOHLTC does not provide a detailed breakdown of the Accounting Transactions by facility or submission sources. As such, when calculating your % overhead, you may need to include or exclude the Accounting Transactions accordingly.


Related: How to Remove a Custom Facility


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