Our primary task as billing specialists for physicians in Ontario is to process claims with a keen and critical eye. We review, interpret, correct and keep track of our physicians’ billing habits, continually looking for potential errors, missing information, and claims that fall outside of normal billing parameters.
Medical Billing Audits
Given the volume of OHIP billing that JCL has processed for hundreds of physicians over the years, we have had very little occasion to deal with serious payment integrity issues. That said, once or twice a year our doctors do receive letters from the Ministry of Health requesting further information about their medical billing.
In 2005 and 2006, the Ministry of Health and Long Term Care drastically overhauled their process for auditing physicians’ OHIP billing. The revised process, called the Payment Integrity program, is still in effect and is intended to ensure that physicians bill OHIP properly for their services.