Optimizing Healthcare Claims Processing Workflow in Ontario

Healthcare claims processing is a critical task that can greatly affect the revenue cycle of healthcare providers. In Ontario, the Ontario Health Insurance Plan (OHIP) is the provincial health insurance program that provides coverage for medically necessary physician services. As a healthcare provider, charting clearly and optimizing your claims processing workflow can help you ensure timely reimbursements and reduce the risk of denied claims.

Here are some of our client’s favourite tips to help you streamline your OHIP claims processing:

1. Ensure Accurate Documentation: Clear clinical notes and records are crucial to avoid denied claims. As an Ontario physician, you must adhere to the billing rules and guidelines outlined by OHIP. This includes ensuring that all claims are submitted with complete and accurate patient information, including their OHIP number, date of birth, and any other relevant details. Clear charts ensure that any disputed, rejected or audited claim can be clearly rectified.
2. Implement Automated Claims Processing: Automating your claims processing can help you reduce errors and increase efficiency. OHIP offers an online billing system that enables healthcare providers to submit claims electronically. This can save time and streamline the claims processing workflow.
3. Verify Patient Eligibility: Verifying patient eligibility is critical to avoid denied claims. OHIP provides healthcare providers with a real-time eligibility verification system that allows them to confirm patient coverage before providing services. If you don’t have access to this already, check with your EMR company to see if they can add this for you.
4. Monitor and Analyze Claims: Monitoring and analyzing your claims can help you identify trends and opportunities for improvement. This can help you make informed decisions to optimize your claims-processing workflow and improve your revenue cycle.

By implementing these tips, you can optimize your claims processing workflow and improve your revenue cycle. At Physicians First Financial, we can help you streamline your claims processing and billing practices to maximize your revenue and minimize denials.