Post-Payment Accountability Steering Committee

Learn about the committee’s mandate and terms of reference

Mandate

In January 2020, the Physician Services Committee established the Post-Payment Accountability Steering Committee to oversee the implementation of changes to the administration of OHIP payments and related processes, specifically through development of the policies and procedures associated with the audit process, and educational materials to assist physicians with billing. Specific objectives included:

  • Ensure procedural fairness, impartiality, accountability and transparency in the new audit process
  • Inform members about new billing education resources developed collaboratively between the OMA and Ministry of Health
  • Educate physicians about the new physician payment audit process
  • Raise physician awareness about their rights and educational resources that support appropriate billing
  • Increase physician engagement with these materials
  • Revise the communications materials used by OHIP to when engaged in an audit
  • Reduce claims payment errors

Background

The Plan to Build Ontario Together Act, 2019, was passed in December 2019 and includes legislative amendments to OHIP payment accountability, including amended Health Insurance Act provisions related to OHIP payments to physicians.

The MOH and the OMA have committed to continuing to work together to implement specific accountability items. Through the PSC, the parties agreed to establish the Post-Payment Accountability Implementation Steering Committee for this purpose.

Background

Learn more about the background behind OHIP accountability implementation

Objectives

Learn about the objectives of the steering committee

Committee work

Get all the details about the committee's work

Planning

More on the timing and reporting of the committee

Contact us

Members are encouraged to reach out to the OMA if they require further information or clarification, and to contact the CMPA if they require representation and assistance in responding to a post-payment audit.

info@oma.org

Objectives

The steering committee will establish joint MOH/OMA working groups and will provide ongoing guidance to each working group as required for the purposes of implementing the objectives identified below.

Each objective will be completed by the dates noted, and the steering committee will present all recommendations to PSC in February 2021.

  • Determine the source of major billing difficulties and use this to develop educational material
  • Identify eligible physicians and when they would participate
  • Determine difference in education for new physicians vs. physicians in practice
  • Develop online materials to improve physician education
  • Develop education material on reading and applying the Schedule of Benefits (the schedule)
  • Develop education material on the steps in the physician payment audit process to ensure accountability and procedural fairness
  • Establish best practices for communicating with physicians on billing information
  • Improve supports for billing inquiries

Long-term goals (recommendations for future work)

  • Develop billing education modules by specialty
  • Develop billing education for staff and billing agents
  • Seek to link billing education to Continuing Medical Education credits
  • Consider evaluation of effectiveness of education

  • Identification and prioritization of potential clarifications by both MOH and OMA sections with a focus on items that may lead to payment concerns
  • Clarification drafting
  • Implementation communications
  • Liaise with EPC to ensure any changes are reflected in educational material

Long-term goals (recommendations for future work)

  • Major revision of the schedule and/or review alternative to the current schedule

  • Provide advice on the method and time frame to publicly report
  • Provide advice on the necessary context to be provided in conjunction with release of payment information

  • Establish communication templates for entire profession and also individual doctors
  • Policies and procedures for internal MOH fee-for-service audit processes including identification of potential billing concerns/audit focus, policies and procedures for on-site review, and general audit process communications

  • Develop recommendations on length of time for claims submission, including any mitigation strategies if there are changes
  • Reduce administrative burden associated with rejected claims (such as newborn rejections)
  • Address pre-payment issues
  • Establish consistent parameters for claims review across OHIP claims offices

Long-term goals (recommendations for future work)

  • Certify third-party billing software

 

The steering committee will bring forward joint recommendations to the PSC for endorsement prior to implementation. All recommendations will support the implementation of amended audit processes by May 2021. 

If the steering committee is unable to develop a joint recommendation for any of the above-noted items, the matter will be referred to the PSC.

Composition

The steering committee will be composed of two representatives from each party, with one representative from each party identified as the co-chair, plus appropriate technical support staff.

MOH representatives

  • Pauline Ryan, co-chair
  • Dr. Stewart Kennedy

OMA representatives

  • Dr. Silvia Orsini, co-chair
  • Dr. Steve Papp

Claims Adjudication Subcommittee

The MOH and the OMA established the CASC to also deal with pre-payment issues, as well as helping to reduce administrative burden for physicians.

Learn more

The parties may determine the makeup of working groups as is needed for the purposes of completing the objective items. The makeup of working groups may differ for each of the objective items and may change over time as work towards completion of each item evolves.

The parties will be responsible for expenses related to their own representatives and staff.

Administrative support for the purposes of meeting scheduling and coordination will be provided by the MOH.

The steering committee may consult with outside parties and experts to support the completion of objectives.

Committee work

  • Determine scope of work related to PPA
  • Assign work to subcommittees and/or staff
  • Review and approve work plans and timelines
  • Provide oversight of work
  • Resolve conflicts in recommendations, if possible
  • Make recommendations related to long-term goals

Timing and reporting

The steering committee will work with each working group to develop a work plan(s), including prioritization of objective items and target timelines, and will present the work plan to PSC for endorsement.

The steering committee will meet monthly or as required to hear and address matters that require the attention of the committee. Meetings may be established at the request of either co-chair or at the request of working groups through their respective co-chair.

Meetings may be held in person or by teleconference/videoconference as deemed appropriate by the co-chairs.

The steering committee will provide regular status updates on the progress of work and will present recommendations to the PSC as needed or as requested by the PSC.

 

* The Publishing Payments working group was subsequently put into abeyance as the ministry indicated there is currently no timeline to proceed with publishing payments in the near future. The ministry will advise if this changes, and the group will resume its work.