How to bill uninsured patients during COVID-19 - Ontario
1. For services provided in a hospital
Physicians who perform services for uninsured patients in a hospital setting will be remunerated by the hospital at existing rates listed in the Schedule of Benefits for Physician Services (the Schedule). Please discuss with your hospital the details of the process.
2. For services provided in the community
For services performed outside the hospital setting, the ministry has introduced the following temporary OHIP fee codes for COVID-19 for the provision of medically necessary physician services provided to uninsured patients in the community.
These codes are for services rendered on or after March 21, 2020.
- K087: minor assessment of an uninsured patient provided in-person or by telephone or video or advice or information provided in-person or by telephone or video to an uninsured patient’s representative regarding health maintenance, diagnosis, treatment, and/or prognosis
- a: intermediate assessment of an uninsured patient provided in-person or by telephone or video, or advice or information provided in-person or by telephone or video to an uninsured patient’s representative regarding health maintenance, diagnosis, treatment, and/or prognosis if the service lasts a minimum of 10 minutes; or
- b: psychotherapy, psychiatric or primary mental health care, counseling or interview conducted by telephone or video, if the service lasts a minimum of 10 minutes
- K089: psychotherapy, psychiatric or primary mental health care, counseling or interview conducted in-person or by telephone or video per unit (unit means half-hour or major part thereof)-per unit
Please refer to the OHIP Bulletin 4756 for more details about the claim submission requirements.
For the instructions on submitting these codes in our system, please refer to How to Submit K087 / K088 / K089.
What if the services I provided do not match the description of K087/K088/K089?
No other fee schedule codes have been implemented for specialist services provided to an uninsured patient. If a claim is rejected with error code EH2 or EH4 because the health card is expired, physicians can:
a) Resubmit the claim once the patient renews their OHIP.
b) If the patient has passed away, unfortunately, physicians can submit the claim flagged for manual review along with the documentation for the services provided.
If the patient does not have health coverage at all, physicians may choose to directly bill the patient.
For more billing tips, please check out our Billing Tip Library.
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