OHIP Billing Services: A Cost-Benefit Analysis

OHIP billing services

Working with a company like JCL Medical for outsourcing your OHIP billing services does have a cost, with rates in Ontario typically falling between 2% to 2.5% of paid claims. It’s not an easy decision to hand over a chunk – even a small chunk – of revenue. Each doctor must continually compare the costs of using a medical billing company with the benefits they receive.

Have your cake and eat it too

But should our service be considered a cost in the usual sense? What side of the ledger – revenue or expense – should our services fall under? Before we get to this strange question, here are some key reasons why our clients use JCL to manage their OHIP billing needs:

  • Our clients don’t need to purchase software, training, or updates
  • Our clients don’t have to take the time to process billings
  • Our clients don’t have to deal with reconciliation of claims or chase down information
  • Our clients rarely have to deal with MOH about billing issues
  • Our clients don’t have to worry about third party and private bills
  • Our clients gain peace of mind because they know their work is being dealt with properly and professionally

In other words, our clients save time and energy and in that sense, our clients believe that what they gain is certainly worth the fees they pay.

The Pay-Off?

But here’s the great thing about working with a competent billing company: They can find ways of improving a physician’s bottom line either by identifying codes they should be using or by following up claims more effectively. This leads to faster payment, fewer write-offs, and a better revenue capture rate. In fact, the gain in revenue and decrease in outstanding claims can often be enough to cover the costs of the fees! That’s called having your cake and eating it too.

An example:

A couple of years ago we had a call from a doctor who, despite hearing about us for over a year, had delayed in contacting us. He had been looking after his own billing. When the doctor started with JCL, we asked him why he was not billing any admission assessment premiums codes on his Emergency Department consultations. He informed us that he was not aware of the code. Ouch. This code had been introduced about 18 months before we started managing this physician’s claims. Conservatively, he missed out on about $400 per month of lost revenue from this code alone. Our usual invoice for this physician was only about $300, which means that, by working with JCL, he had an extra $100 per month in cash flow AND didn’t have to worry about his billings. That’s a good deal.


Is this typical though? Probably not. Most physicians who ‘go it alone’ or use office admin to look after their billing needs are aware of new codes and changes to the Schedule of Benefits. They talk to colleagues and pay attention to trends. For these doctors, the benefits of using a billing company are not so financially dramatic. Still, it does not take much in the way of increased revenue or better follow up to cover the fees associated with our service. If you want your cake (more free time, more peace of mind) and you want to eat it too (increased revenue, decreased rejections), give us a call to see how JCL can enhance your practice.

Interested in knowing all your OHIP billing options? Check out our blog:

New Doctor? You Have Options