What is a Schedule of Benefits?
A schedule of benefits is a list of various medical services that doctors are able to bill the government for. Each medical service is given a specific code and a fixed dollar amount that the government has agreed to pay the doctor for that service.
What is the OHIP Schedule of Benefits and How Does it Work?
Therefore, the Ontario schedule of benefits was created by the Ontario Ministry of Heath and outlines each fee code for each speciality, along with its rules and when to use it. It’s a PDF document and is nearly 740 pages long.
It was created mainly for doctors who work under the fee-for-service model. This is a payment model in which you must submit 'invoices' to the Ministry of Health (OHIP) of who you saw and what you did in order to be properly reimbursed for your services. The general process is:
You see a patient
You fill out a claim using a special code that explains what service you provided (known as a fee schedule code)
You submit that claim to OHIP for payment
OHIP reviews the claim and reimburses you if it’s approved.
As stated above, each service has an OHIP diagnostic code that corresponds to a specific dollar amount. For example, if you’re a GP and you see a patient for a visit you can submit a claim with the fee code A005 (Consultation). This fee code has a value of $77.20, which is how much OHIP would reimburse you for.
Sounds easy enough right? The difficult part though, is remembering which fee code to use for the services you’ve provided and trying to search through the PDF to find exactly what you’re looking for and if you’re eligible.
What’s the Best Way to Use it then?
Unfortunately, being such a huge document (as it lists around 6,000 services) this makes searching for actual diagnostic codes extremely time-consuming, not to mention that the actual descriptions are, you’ve guessed it, not the easiest to read.
This is may be why a lot of Ontario doctors are used to getting rejections and aren’t bothering to follow up on them; the reality of not being able to find the correct code to use can be both frustrating and tedious.
The good news then? (Yes, there can be good news when referencing the schedule of benefits), with the help of our OHIP billing experts we’ve made things a whole lot easier by creating a searchable database of all OHIP diagnostic codes.
Simply click below and save it as a favourite so you can quickly reference, and find, all OHIP diagnostic codes anytime, anywhere.
To get started, search by speciality, code or keyword:
Getting an Error Code? Find out what it means…
If your claim was sent back with an error code, use this searchable database to look the error code up and find out what the issue is:
How claim submission works on Dr. Bill
Under the fee-for-service model, Ontario physicians have to submit their claims of who they saw and what they did through the medical claims electronic data transfer ( MC EDT ) system. Essentially, Dr. Bill is connected to this system and allows you to upload your claims from your smartphone.
You can take a picture of a patient label and then create and submit a claim within a few taps. You can review your submissions and manage all payments on the web app.
Doctors use our system alongside their EMRs – submitting their billings as they work and never missing a claim again. Our team of in-house billing agents are also there to help and manage your rejections for you.
If you have any questions in regards to the OHIP Schedule of Benefits or any fee code, please don’t hesitate to contact our billing team today.