Ontario overhauls medical audit regime

Kondro, Wayne
August 2007
CMAJ: Canadian Medical Association Journal;8/14/2007, Vol. 177 Issue 4, p334
Academic Journal
The article reports that Ontario legislature has passed a bill to make the province's medical audit system less onerous. Ontario Medical Association (OMA) president Janice Willett says that the new system addresses many shortcomings of the previous one, and also provides accountability on physician billing. It is informed that the new system calls for setting up of a Physician Payment Review Board which will have the power to suspend a physician's right to bill Ontario Health Insurance Plan (OHIP). The new system reportedly has a provision that allows physicians to recover legal costs, and also incorporates a new method for calculating interest awards.


Related Articles

  • Practices can use Medicare appeals process to advantage. Jerram, Karen // Ophthalmology Times;09/15/99, Vol. 24 Issue 18, p26 

    Discusses the five steps in the appeals process regarding the Medicare benefits and claims in the United States. Information on who can appeal for an explanation of Medicare benefit statements detailing payments that the Medicare has made and claims it denied; Details on the requirements for...

  • Risk Management: The Role of Peer Review in Potentially Compensable Event and Medical Malpractice Claims Processing in the Army Medical Department. Kutsch, Anthony J. // U.S. Army Medical Department Journal;Jan-Mar2010, p20 

    The article discusses the difference between peer review and risk management (RM) peer review as used in the context of medical malpractice claims processing in the Army Medical Department. It sasys that peer review is used in the RM setting to advance the RM objectives of keeping the loss of...

  • ICD-9 Changes: It's Time to Tend to Your Superbill. Hughes, Cindy // Family Practice Management;Sep2005, Vol. 12 Issue 8, p49 

    This article reports that the ICD-9 updates have been released in the U.S. and it discusses the effects on physicians. Doing this work now could save one the time and trouble of correcting and resubmitting claims that are denied because of out-of-date diagnosis codes. Some codes will have their...

  • Ontario overhauls medical audit regime. Kondro, Wayne // CMAJ: Canadian Medical Association Journal Supplement;8/14/2007, Vol. 177 Issue 4, p334 

    The article reports on a provincial legislation that limits abuses of the predecessor of the medical audit system in Ontario. According to Doctor Janice Willett, Ontario Medical Association (OMA) president, the new system which will provide transparency and fairness will address many of the...

  • Partnering on Claims Processing. Minich-Pourshadi, Karen // HealthLeaders Magazine;Jan2011, Vol. 14 Issue 1, p47 

    The article discusses the results of the 2010 American Medical Association's National Health Insurer Report Card which concerns medical claims processing errors. It mentions that one in five medical claims is erroneously processed, totaling over 15 billion U.S. dollars annually. The article also...

  • Feeling punchy. Conn, Joseph // Modern Physician;Jan2002, Vol. 6 Issue 1, p13 

    Highlights the failure of insurers to pay physicians on time in the United States. Alleged interest of doctors according to insurers; Innovations in claims processing; Insurers that lead in electronic claims adjudication.

  • Back to the Future: Recognition of 'Medical Monitoring' Claims in Florida. DiPaola, Theresa A. // Florida Bar Journal;Dec2000, Vol. 74 Issue 11, p28 

    Examines the placement of medical monitoring lawsuit in the tort system of Florida. Definition of medical monitoring claim; Discussion of cause of actions defined in the Petito standard; Concerns over the application of medical monitoring; Potential applications of medical monitoring to other...

  • Working Down Denials. Hanna, Sarah // HomeCare Magazine;Apr2007, Vol. 30 Issue 4, p16 

    The article offers information on C0175 denial code attached to a Medicare claim where payment is denied due to incomplete prescription in the U.S. According to a report from medical equipment providers, C0175 is the fourth highest reason for Medicare claims denial. The code indicates that an...

  • Stay on Top of Widespread Edits to Keep Your Claims Safe.  // Eli's OASIS Alert;Mar2011, Vol. 12 Issue 3, p15 

    The article reports on the essence of widespread edits for keeping safe claims. As stated, widespread edits automatically reroute claims which are at risk of payment errors for review before payment. It provides an overview on some of the current widespread edits concerning diagnosis codes...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics