Chapter 1:
Medical Billing in Ontario

3-minute read

Medical billing has a (well-earned) reputation for being complicated. However, with a solid foundation of the basics, it can quickly become a straightforward part of your day. 

1.1 Physician Payment Models

Canadian doctors get paid in a variety of different ways. Depending on your situation, you may even be compensated through multiple payment models at the same time. 

Download for free, the full version of our Ultimate OHIP Billing eBook to learn the basics of the three most common payment models:

  • Fee-For-Service
  • Salary
  • Alternative Payment Plans (APPs)

Did You Know?

APPs are on the rise and vary widely. Generally, they are made up of a combination of:

  • Fees for clinical services
  • Time-based payments
  • Rewards for participation in specific clinical initiatives
  • Population or capitation payments
  • Payment for admin costs
  • Bonuses for achieving specific targets

1.2 OHIP Schedule of Benefits

This section of our Ultimate OHIP Billing eBook offers a quick overview of the OHIP Schedule of Benefits and Fees. The Schedule of Benefits is the official document from the Ministry of Health that lists all OHIP-insured services as well as all billing and diagnostic codes with corresponding descriptions, rules and dollar amounts.

Did you know?

The OHIP Schedule of Benefits is approximately 1,000 pages long! (Thankfully, most specialties have a core set of frequently-used codes and rules, which makes billing less daunting than it seems.)

1.3 How Claims are Submitted

OHIP claim submission works through an electronic data system known as the Medical Claims Electronic Data Transfer (MC EDT) system. It’s a secure system that allows you or third-party software providers to submit claims to OHIP. 

Download the full version of our Ultimate OHIP Billing eBook to learn how to become an authorized MC EDT user and walk through the basics of submitting a claim.

1.4 How And When Physicians Get Paid

OHIP claim submissions and payments run on a monthly cycle. All claims you submit by the OHIP cut-off date (the 18th of each month) will be processed for payment by the 10th business day of the following month. 

The surest way to never miss a cut-off date? Sign up for OHIP cut-off reminder emails. Each email comes with a billing tip to help you optimize your billing and keep you up to date with important Ministry changes

The Ultimate OHIP Billing Guide

1.5 OHIP Reports You’ll Receive

During the first week of each month, physicians receive two reports from OHIP:

  1. Remittance Advice (RA) Report
  2. Claims Error Report

These reports are helpful for bookkeeping and essential for keeping track of any claims you submitted during the last month.

Chapter 2: Getting Your OHIP Billing Number (And Beyond)