OHIP
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| Define an assessment service code | A code assigned to every service and proceedure changed in addition to the assesment code. Type of examination performed by the doctor ie: immunization, ear, suturing.
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| Define a diagnostic code | A code assigned to every diagnosis for use in billing. Complaint of patient (reason for the visit) ie: flu, headahe, nausea
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| Explain what a version code is, example why they are used | Version code on a health card, there are letters at the end of the numbers used to verify claim.
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| List five reason a person would need to contact a Ministry of Health Office with respect to their health card | If the card is lost or stolen. Name has changed. Incorrect information Card has expired, no longer require coverage Card has been damaged
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| Describe the two different types of health cards | Red and White health card old style Photo health card picture/trillium card (new one)
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| What three things are needed to obtain a new health card and why are these three things needed | Birth certificate citizen ship, Drivers licience, Sin Card verify's who you say you are
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| What is the penalty for health care fraud | For individual $15,000 or six month in jail. For corporation $25,000 and jail term
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| List four steps that can be taken to prevent health card fraud | Ask Pt to present card at visit. If office has scanner, verify information Check a expiry date of all photo cards if patient presents without his/her card, have them sign a health number release form. Report lost stolen card at every visit
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| There are three components to a service/assessment code. What does each component stand for | first character: alph prefix (location) numeric protion proceedure. Middle: numeric service identifier (actual proceedure) Last Character alph suffix (who performed the service)
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| Consultation | a second opinion requested by either the physician or patient
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| Limited Consultation | All ellements of a full consultation but in reduce time. A second opinion requested by either the physician or the patient
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| General Re-Assessment | 2 per year, same service as general assessment but it does not need to be as detailed, must have the same diagnosis as the previous general assessment. Seen already that year for same complaint
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| Minor Assessment | A brief history of the affected parts region/ system, quick checks, rechecks, on infection, sture removal, prescription renewal
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| Special Visit | Initiated by patient, means physician is required to travel from one location to abother, emergency call, outside office hours
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| WSIB | Services are submitted under payment program WSIB and WCB reimbursews OHIP Form 8 is used for 1st time doctor examines injured worker
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| Reciprocal Billing | Services rendered to insured patients from another province (with the exception of Quebec.
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| Third Party Billing | Uninsured services, ie: companies, medical. Is a type of uninsured billing when a private insurance company, employers orders a patient to be assessed by physicians.
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| Who pays for health care coverage premiums | Coverage is paid for by all employers in the form of tax. The patients is required to pay cash for services. The patient then submits the receipt to the party ordering the proceedure
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| Explain the difference between a service code and an assessment code | Assessment: code is a description of the examination performed by the MD (ie: physical)and each office visit. |Service /proceedure: ie: immunization, a code assigned to every diagnosis for use in billing.
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