Ontario Health Insurance Plan

INFOBulletin

Hospitalist & Internal Medicine Premiums-Retroactive Payment

The final retroactive payment for the Hospitalist Premium and Internal Medicine Office Assessment Premium will be made on the June 2021 RA.


To: All Physicians
Category: Physician Services
Written by: Health Services Branch, Ontario Health Insurance Plan Division
Date issued: May 25, 2021
Bulletin Number: 210504


Background

The Ministry of Health (ministry) and the Ontario Medical Association (OMA) have been working together to implement physician compensation increases in accordance with the 2019 Kaplan Board of Arbitration Award.

The new Hospitalist and Internal Medicine Premiums were effective April 1, 2020 with an implementation date of November 1, 2020. For details on eligibility and payment criteria, refer to INFOBulletin 201106 and to the General Preamble of the Schedule of Benefits for Physician Services.

The payments for the Hospitalist and Internal Medicine Premiums were automated effective November 1, 2020, with measures put in place to issue retroactive payments for eligible services rendered from April 1, 2020 to October 31, 2020. For eligible claims with service dates on or after November 1, 2020, the Hospitalist and Internal Medicine Office Assessment Premium payments have been made monthly and have been reported on the solo or group Remittance Advice (RA) under which they were billed, in the Premium Payments section. The first automated payment appeared on the December 2020 RA.

Hospitalist and Internal Medicine Office Assessment Premiums-Retroactive Payments

An interim retroactive payment for the Hospitalist and Internal Medicine Office Assessment Premiums for claims previously submitted with service dates for the period of April 1, 2020 to October 31, 2020 was paid on the solo January 2021 RA and reported under the Accounting Transactions section of the RA.

The final retroactive payment for the Hospitalist and Internal Medicine Office Assessment Premiums, for eligible services between April 1, 2020 and October 31, 2020, will be paid on the June 2021 RA. This will report under the Accounting Transactions section of the solo RA. Eligibility for these premiums has not changed since the interim payment was issued.

Providers will see a recovery for the value of the interim payment that was issued on their January 2021 RA and a payment for the full final value of the premium on the June 2021 RA. Both transactions will report under the Accounting Transaction section of the June 2021 RA with the description “Hospitalist Premium” and/or “Internal Medicine Premium”.

Hospitalist and Internal Medicine Office Assessment Premiums-Annual determination of eligibility

Eligibility for the Hospitalist and Internal Medicine Premiums is determined annually on November 1. Determination of eligibility is based on claims for services provided in the preceding fiscal year (April 1-March 31). Once a physician is determined eligible for either of these premiums, automated premium payments will be made for a period of 12 months on eligible services (November 1-October 31).

For example, claims with service dates between April 1, 2020 and March 31, 2021 will be used to determine eligibility for these premiums effective November 1, 2021. Eligible physicians will receive automated premium payments on eligible services provided between November 1, 2021 and October 31, 2022.

Keywords/Tags

Kaplan; Hospitalist Premium; Internal Medicine Office Assessment Premium; Year 4; Release 5

Contact Information

Do you have questions about this INFOBulletin? Email the Service Support Contact Centre or call 1-800-262-6524.

Find INFOBulletins online on the Ministry of Health website.

For More Information

Call ServiceOntario, Infoline at:
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TTY 1–800–387–5559.
In Toronto, TTY (416)327–4282
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