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QUESTIONS
AND ANSWERS
CLARIFICATION OF COMMENTARY REGARDING DIAGNOSTIC HEARING
TESTS
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Is compliance with professional standards a condition of
payment for insured services?
Yes. Section 18(1) 6. of
the Health Insurance Act authorizes the ministry to refuse payment for an insured service if it has not been provided in accordance with accepted professional standards and
practice.
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For OHIP payment purposes, is a physician permitted to
delegate 'communicating a diagnosis' or 'prescribing a hearing
aid' to non-physician employee?
No. These controlled acts
are normally performed as elements of an assessment. Insured
assessments must be personally performed by the physician and, for
payment purposes, cannot be delegated to a non-physician.
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Is this a change of payment policy?
No. The revision to
the Commentary pertaining to delegation and supervision of DHTs
represents only clarification of existing policy but now explicitly
acknowledges the distinction between controlled and uncontrolled acts.
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