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Payment Integrity Program Independent Health Facilities Unit

This presentation outlines the Independent Health Facilities Payment Integrity Program (IHFPI) aimed at improving billing practices in Ontario's Independent Health Facilities (IHFs). With approximately 935 IHFs operating and a significant volume of diagnostic services provided, the program focuses on monitoring unusual billing patterns, educating facility operators, and facilitating communication for better compliance with provincial standards. Key goals include promoting accountability, ensuring financial integrity, and enhancing the quality of healthcare services delivered in IHFs across the province.

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Payment Integrity Program Independent Health Facilities Unit

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  1. Payment Integrity ProgramIndependent Health Facilities Unit Presentation to IDCA Presented by: George Clarke Diagnostic Services & Planning Branch Date: September 20, 2013

  2. Independent Health Facilities Payment Integrity Program (IHFPI) Table of Contents • IHFs – Overview Page 3 • Background Page 4 • Goals Page 5 • Monitoring Processes Page 6 • Education Page 7 • Communications Page 8 • Questions / Comments / Feedback Page 9

  3. Independent Health Facilities (IHFs) - Overview • Ontario has approximately 935 Independent Health Facilities (IHFs) • They provided 9.1million tests in 2011/12, a 4.3% increase over 2010/11 • 53% of all diagnostic services are performed in IHFs (among services for which they are licensed) in 2011/12. • The largest category of services provided in IHFs are diagnostic radiology and ultrasound services • Diagnostic ultrasound is the largest area of growth, increasing by 6% over last fiscal year • 61% of all ultrasound and 71% of all sleep studies were performed by IHFs

  4. IHFPI Program - Background • In 2012, the Office of the Auditor General of Ontario (OAGO) conducted an audit of the Independent Health Facilities (IHF) Unit. • The audit recommended that the Ministry of Health and Long-Term Care (“the ministry”) periodically review IHF billing data to identify facilities with unusual billing patterns.

  5. IHFPI Program – Goals and Functions To review unusual billing practices, engaging the leadership community of IHFs in understanding the patterns that results in accountability practices consistent with provincial standards. The Program’s three principal functions are: • Monitoring billing practices; • Educating IHFs about acceptable billing practices; and, • Communicating with targeted findings either to specific licencees or by sectors.

  6. IHFPI Program – Monitoring Processes Case management system will be created to: • Allow for billing pattern analysis; • Track status and outcomes of unusual billings; • Fulfill the recommendation of the Provincial Auditor.

  7. IHFPI - Education • Educational materials will be created that will instruct IHFs to ensure compliance with provincial billing standards • Eg. Bulletin 2085- Schedule of Facilities Fees Preamble posted on February 12, 2013 • To assist Independent Health Facility (IHF) licensees understand their obligations and requirements for submitting facility fee billings for processing and payment, the ministry has added preambles to each section of the Schedule of Facility Fees for Independent Health Facilities (Schedule)

  8. IHFPI - Communications • Communication tools will be created for both specific cases or general sector communications • Targeted letters to individual licencees regarding unusual billings • Sector letters

  9. Questions / Comments / Feedback • Comments / suggestions re program materials, points for discussion, etc.?

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