Every year, the Ontario Medical Association updates its annual Physician’s Guide to Uninsured Services, adding new non-OHIP covered services, adjusting suggested fees, and providing additional recommendations on managing uninsured services billing. Staying on top of the latest changes is essential for physicians to navigate their billing practices effectively and minimize revenue loss.
In this blog post, we highlight the most frequently requested uninsured services, outline the fee adjustments for 2024 in Ontario, and provide solutions such as block fee payments to help streamline your billing processes. Our goal is to empower physicians to make informed decisions, optimize billing practices, and ensure you are compensated for the care you provide.
Frequently Requested Uninsured Services
In their daily practice, physicians often receive requests for services not covered by OHIP, such as prescription renewals, sick notes, and various forms for school, work, or insurance purposes.
Delivering these services can consume a significant portion of a physician’s day, and the prospect of collecting payment for these services adds another layer of complexity. Many physicians find this aspect of their work particularly daunting due to the lack of clear guidelines and the variability in what patients might be willing or able to pay.
Therefore, it is essential for physicians to stay informed about the latest changes to the suggested fees for uninsured services and adopt a systematic approach to billing and collecting payments for these services.
Fee Multiplier Increase
One significant change in this year’s update is the fee multiplier. The OMA has increased the fee multiplier from 2.60 to 2.70, a modification applicable to nearly all fee categories. This adjustment highlights the importance of reviewing fee changes and aligning billing practices accordingly.
Fee Adjustments for 2024
In the table below, we have summarized the fee adjustments for uninsured services from 2023 to 2024:
| Suggested Rate | |
Uninsured Services | 2023 | 2024 |
Charges for Reproduction/Transmission of Medical Records:
Copying/printing; or Electronic transfer; and
Physician review of records (where applicable) | $30 (first 20 pages) + $0.25 every additional page
$30
$45 per 15 minutes, after first 15 minutes | $30 (first 20 pages) + $0.25 every additional page
$30
$45 per 15 minutes, after first 15 minutes |
Completion of documentation/forms for physicals for schools, camps, pre-school, daycare, university/educational institutions |
$32.50
|
33.75 |
Completion of documentation/forms for physicals for pre-employment certification of fitness/fitness clubs or hospital/nursing home employee |
$43.25 |
$44.75 |
Back to work note, sick note or daycare note (free of communicable disease) |
$22.75 |
$23.50
|
CRA Disability Tax Credit Certificate (form T2201) | Physician’s hourly rate (1)
| Physician’s hourly rate |
Insurance Certificate OCF- 3 Disability Certificate | $164 | $240 |
Insurance Certificate OCF- 18 Treatment Plan | $164 | $255 |
Insurance Certificate OCF- 23 Treatment Confirmation | $163 | $240 |
Attending Physician’s Statement | Physicians hourly rate (2) | Physician’s hourly rate |
Insurance Medical Examination (assessment and report) | Physician’s hourly rate | Physicians hourly rate |
Medical Report for a CPP Disability Benefit (SCISP- 2519) | Variable (3) | Variable |
CPP Narrative Medical Report | Variable (3) | Variable |
(1) Suggested minimum fee of $150.00
(2) Suggested minimum fee of $160.00
(3) For CPP reports, Service Canada will pay up to $85 and $150, respectively; if a physician’s fees are higher, the patients are responsible for covering any extra costs.
These updates reflect evolving healthcare needs and ensure fair compensation for services performed. However, it’s important to recognize that these rates are guidelines rather than mandates. While physicians can set fees based on their preference, aligning with suggested rates is advisable, especially as many services transition from insured to uninsured.
Note: To view the full 2024 OMA Physician’s Guide to Uninsured Services, log into your OMA account here.
Implementing a Block Fee Program
Many physicians collect payment on a fee-for-service basis for their uninsured services. However, simplifying payment collection methods allows for more seamless transactions for physicians and patients. In addition to traditional fee-for-service billing, physicians can implement a block fee program as a convenient alternative for managing uninsured services. A block fee is a flat fee that covers a predetermined set of uninsured services for one year.
Benefits of block fees:
- Convenience for patients: block fees offer patients a simplified payment structure, eliminating the need to handle individual payments for each uninsured service. With a single upfront payment, patients gain access to a comprehensive range of services throughout the year, enhancing their overall experience and reducing financial stress.
- Predictable revenue for physicians: by offering block fees, physicians can stabilize their revenue stream and reduce the uncertainty associated with fee-for-service billing. With upfront patient payments, physicians can better forecast their income and allocate resources accordingly, improving financial stability and practice management.
- Time-saving administrative process: managing individual payments for uninsured services can be time-consuming and resource-intensive for both physicians and administrative staff. Block fees significantly reduce administrative overhead, as physicians can streamline billing processes and focus their efforts on delivering quality patient care.
Due to the nature of their specialty or practice structure, not all physicians can charge a block fee. However, for those who can, offering an annual fee presents a practical alternative to traditional fee-for-service billing. This method can significantly reduce the time spent on administering uninsured services, saving both the physician and patient considerable time and effort.
In an earlier blog, we spoke with Dr. Fadie Amin, a full-time family physician practicing comprehensive care who shared insights about finding the right balance when it comes to charging patients for uninsured services as well as how Doctors Services has positively impacted his practice.
Read the full blog to learn more about Dr. Fadie Amin’s experience with Doctors Services:
Uncovering the Costs of Uninsured Medical Services to your Practice
Take Uninsured Services Billing Off Your Plate!
We understand you may not have time to set up an uninsured services program and determine their rates. Our team of experts at Doctors Services can assist you with various services, including uninsured billing education, invoicing, patient reminders, and setting up block fees for your patients. By taking advantage of our comprehensive payment collection solutions, you can streamline your processes and focus on what matters most – providing excellent patient care.
Interested in learning more about our services? Contact us today at info@doctorsservices.ca.
