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OHIP Billing Tip #44 - Hospitalist Premiums (17%)

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How do I know if I'm eligible for the Hospitalist Premiums (17%)

Physicians practicing as Hospitalists and submitting claims for the qualifying services are eligible for the 17% Hospitalist Premiums, when the following criteria is met:

  • The physician has provided at least 1500 qualifying services in the qualifying year; and
  • The physician has provided at least one qualifying service per day on at least 110 days in the qualifying year; and
  • The physician is a General and Family Practice (00) or an Internal Medicine (13) specialist.

 

To confirm if you are eligible for the premium, you can obtain the required information as follows:

  1. Generate an Export Claim report (under REPORTS&FORMS -> Advanced Reports) for the previous fiscal year (e.g. April 1, 2019 - March 31, 2020)
  2. Create a pivot table and retrieve the information for the following:                                                     

a. The number of the qualifying service codes:

  • A933A-On-call admission assessment
  • C933A-On-call admission assessment
  • C002A-Subsequent visit-first five weeks
  • C007A-Subsequent visit-6th to13th weeks
  • C009A-Subsequent visit-after 13th week
  • C122A-Subsequent visit by Most Responsible Physician-day following hospital admission assessment
  • C123A-Subsequent visit by Most Responsible Physician-second day following the hospital assessment
  • C124A-Subsequent visit by Most Responsible Physician-day of discharge
  • C132A-Subsequent visit-first five weeks
  • C137A-Subsequent visit-6th to13th week
  • C139A-Subsequent visit-after 13th week
  • C142A-First subsequent visit by Most Responsible Physician following a transfer from an Intensive Care area
  • C143A-Second subsequent visit by Most Responsible Physician following a transfer from an Intensive Care area
  • C882A-Palliative care-General Practitioner
  • C982A-Palliative care-all other specialties

b. The number of service dates with the qualifying service codes

Eligible physicians will receive a premium of 17% of the approved dollar value for the qualifying services. Payments will be made monthly and reported on the Remittance Advice (RA) – Claim Summary Payment report under Accounting Transactions (see below screenshot)

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For more information, please refer to OHIP Bulletin 201106.

For more billing tips, please check out our Billing Tip Library.

Questions? Check under the HELP tab or send an email to support@mdbilling.ca

 

 

 

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