The Ontario Telemedicine Network (OTN) has a Virtual Care Program (formerly known as the Telemedicine Program) that provides easy access to health care, reduces travelling time, and provides better support for people living with chronic diseases. The goal of the Virtual Care Program is to help doctors with virtual care so they can focus on what they do best – making sure that patients are given the best care possible. In this post, we will share with you how to bill the OTN codes and the benefits of using them to maximize your revenue.
Register for OTN Virtual Care Billing
Before submitting OTN codes, Ontario physicians must submit a registration form to the Ministry. You are eligible to bill under the Virtual Care Program if you are a:
- Family physician in a patient enrollment model (PEM) providing care to rostered patients;
- Specialist physician; or
- GP focused practice physician designation providing care within your focused area of practice
Although the Virtual Care Program leverages the existing OHIP billing codes for virtual care claims submission, these claims are processed separately from OHIP claims and should not be confused with insured services.
To register, physicians must sign and complete the OHIP Virtual Care Physician & Dentist Registration Form.
New OTN Codes for Tracking
As of April 1, 2020, the Virtual Care Program issued two new OTN codes for video visits and direct-to-patient video visits.
|B103A||Video visit when patient is physically located and supported at a patient host site||$0.00|
|B203A||Video visit with a patient in the home or another location of their choice||$0.00|
Note: Utilizing the OTN allows you to bill out of basket codes.
Billing Requirements for OTN Codes
To be eligible for the video visit codes, all physicians must:
- Be eligible to submit claims for the video visits (must have registered with the Ministry).
- Be eligible for services rendered where all participating physicians and patients are in attendance via an approved OTN video solution in Ontario.
- Include the OTN SLI code to indicate a consult was done as a video visit.
- The code must include the applicable Virtual Care Program B-code (i.e. B103A or B203A).
- Not include fee codes for services excluded from the Virtual Care Program.
For more details on the requirements, read the OHIP Telemedicine Information Manual here.
Documentation for OTN Codes
There are many financial benefits to doing your consults by OTN for rostered patients. If you meet the following requirements, these visits can be billed (and are paid) at the same amount as an in-person visit.
- You can only bill OTN codes for rostered patients. Non-rostered patients must be billed using the K-Codes (K080, K081, K082).
- If you are not registered for OTN, you can bill the K-Codes (K080, K081, K082) where appropriate.
- These visits must be documented properly. We suggest you use a slightly modified SOAP note for these visits that includes documentation of patient consent and start/stop times. We can guide you in setting this up in your EMR and can remotely add stamps/templates for your use.
Note: there are no restrictions on the platform you use to set up virtual care, however if your technology of choice has not passed PHIPA rules (where consent is received upon sign up (e.g. with OTN Invite), then you must obtain consent from the patient and ensure it is documented in their chat. The OMA has put together legal verbiage and patient oriented messaging that physicians can use here.
Error Conditions and Explanatory Code Messages
There are nine error codes that are applicable for virtual care claims for services rendered after April 1, 2020.
|ET1||Provider Not Registered for Virtual Care Program|
|ET4||Virtual Care Program B-Code Missing or SLI Code Invalid|
|ET5||Virtual Care Program SLI Code Missing|
|TM1||Duplicate Virtual Care Claim for Same Patient|
|TM3||Service Not Payable Under Virtual Care Program|
|TM4||Non-Virtual Care Claim Already Paid for This Patient|
|TM5||Virtual Care Claim Already Paid for This Patient|
|TM6||Virtual Care Program Registration Not In Effect on Service Date|
|TM7||Dental Services Not Payable Under Virtual Care Program|
We have created an OTN quick reference guide that you can download here.
Need some support billing OTN or other codes? We can help!