test 1

Question 1

average app time

Answer 1

15 min

Question 2

minor ass. app time

Answer 2

5-7 min

Question 3

intermediate ass app time

Answer 3

10 min

Question 4

annual health exam app time

Answer 4

20.40 min

Question 5

initial prenatal exam app time

Answer 5

20-30

Question 6

general prenatal visit app time

Answer 6

10 min

Question 7

well baby visit app time

Answer 7

10-15 min

Question 8

pap app time

Answer 8

10 min

Question 9

counselling app time

Answer 9

30-60

Question 10

patient rostering- what is it?

Answer 10

Process by which patients register with a family practice, physician, or team.
An ongoing relationship between the patient and provider
Key component in primary care models
Formalized though an agreement signed by both patients and providers
A commitment to each party
Core element of care

Question 11

what/who is impacted by patient rostering?

Answer 11

health outcomes, physician-patient commitments, EMR’s, funding strategies, continuity of care, preventive care and chronic disease management, panel size

Question 12

benefits of patient rostering?

Answer 12

benefits family physicians
-clearly define patient population, strengthens relationship continuity, needs of specific groups, identifies research and teaching)

benefits the patient
links patient formally to specific health care provider, timely apps, access to information- referrals, specialists, health services etc.

Question 13

limitations of patient rostering

Answer 13

physicians- time resources, expertise, training IT support, patient has right to seek other primary care setting

captivated payment system- cant roster a patient who is already rostered elsewhere

Question 14

info needed for a claim

Answer 14

Physician Registration Number
Date of Birth
Service Date
Service Code
Diagnostic Code
Number of Services
Price Per Unit
Fee Submitted
Accounting/Claims Number
Payment Program (HCP, RMB, WSIB)
Payee
Referring Physician
Facility Number
Inpatient Admission Date
Manual Review Field
Independent Consideration
Shadow Billing (for family health networks)

Question 15

3 types of claims

Answer 15

1) Services covered under the Provincial/Territorial Health Care Plan
2) Reciprocal claims
3) WSIB

Question 16

claim deadlines

Answer 16

Based on a monthly billing cycle
Claims received by the 18th of the month will typically be processed for payment by the 15th of the following month
When the 18th falls on a weekend or holiday, the deadline will be extended to the next business day
Claims received after the 18th will be processed for payment on a best effort basis and may not be processed until the next billing cycle.

Question 17

file reject message

Answer 17

Rare report – does not happen very often
Indicates that Ministry has rejected entire claims file
Usually due to technical errors
Notified within hours of claim to allow for timely resubmission

Question 18

batch edit report

Answer 18

Report is normally sent within 24 hours of the claim file submission
This is your receipt that the ministry received your file
However, it does not guarantee payment of the submitted claims
If claims are uploaded on a weekend, holiday or at month-end, the Batch Edit Report is delivered on the next claims processing day

Question 19

error report

Answer 19

AKA: Claims Error Report
This report provides a list of rejected claims and the appropriate error codes for each claim
Normally sent within 48 hours – 72 hours of claim file submission
If claims are uploaded on a weekend, holiday or at month-end, the Error Report is delivered at the end of the next claims processing day.

Question 20

group split remittance advice report

Answer 20

This report is only available to individual physicians within a Family Health Network (FHN) or Family Health Organization (FHO) for reconciliation of their own claims

Question 21

group split error report

Answer 21

This report provides a list of rejected claims and the appropriate error codes for each claim
It is only available to physicians affiliated with a FHN or FHO.

Question 22

remittance advice

Answer 22

AKA: Reconciliation Advice
This report is a monthly statement of approved claims
Normally delivered within the first week of the month
RA is produced during a three-to-four day period at the end of the month and is delivered when month-end processing is completed

Question 23

rejected claim

Answer 23

Claim is rejected if it is missing any of the necessary information required to process a claim (ie: missing version code, expired health card, missing assessment/diagnostic codes, etc.)
Each rejected claim will have a code for rejection or underpayment – need to look up code and correct
Try to correct and resubmit as quickly as possible
Have maximum 6 months to make corrections and resubmit claims

Question 24

stale dated claim files

Answer 24

All claims must be submitted within six months of the date of service
Claims submitted more than six months following the date of service must be submitted as a stale dated file
Single claims can be submitted with other claim files but must be identified using the manual review indicator
Supporting documentation must be faxed to your local claims services processing office.