OHIP IHF Payless payment with Code Out ‘80’

Ontario Health Insurance Plan Independent Health Facility Payless payments with a code out of 80

Date of Tech Note: 13 July 1999
Enhancement: 13 July 1999
Bug Fix: N/A

Description

In Ontario Radiology Facilities are called Independent Health Care Facilities. Under the agreement of operation of these facilities, OHIP may pay them less than the agreed payment amount. This underpayment is currently 4.5% of the submitted amount.

When the payments are received from OHIP in the Remittance Advice file they have the payment at 4.5% less than was submitted. MediFile would correctly show the paid amount, mark the billing with a status of ‘PayLess’ and create a payment record with the amount paid.

If you have an IHFacility you could have several hundred of these claims every month. Without using the Change Value feature of MediFile this could take a long time to make the adjusting entries, and change the status to write off.

This enhancement shows how you can set up MediFile to handle this payless amount showing a write off amount and making an adjusting entry for billings from a previous accounting month.

Setting Up the Auto Write Off

As this is a system wide preference, this is to be set in the Administration Preferences.

Additionally this is an Ontario specific billing preference so you need to go to the Province specific billing page of the Administration preferences.

You need to set the two items indicated by the arrows in the previous figure.

• % Paid Write Off Remainder: In this area put the % of the original billed amount for which you want MediFile to automatically write off the remaining amount. In the case where OHIP is reducing the amount paid by 4.5% you may want to have this set at 95%.

• IHF Payless Code Out: This is the code out code that will trigger MediFile to see if it should write off the remaining amount on the bill. Therefore if the code is ‘80’, enter that here.

What MediFile Does

When reconciling the claims, MediFile will get the billing record. When it finds the billing record and there is a code out of ‘80’ MediFile will then check if the paid amount is greater than is set in the Admin preferences as shown previously.

If this is true MediFile will mark the billing with a status of ‘Write off’.

If the billing is from an accounting month previous to the current accounting month, MediFile will create a Adjustment record for the amount written off.