Physician billings: WCB payment program

(disponible en anglais seulement)

Introduction

We want to help physicians understand when it’s appropriate to bill the Ontario Health Insurance Plan (OHIP) using the WCB payment program. The Workplace Safety and Insurance Board (WSIB) pays the cost of services billed using the WCB payment program with money paid into our Insurance Fund by Ontario employers. We need to ensure that these employers aren’t paying for services that should be covered by the Ministry of Health and Long Term Care (MOHLTC).

You can use the information in this document to help you decide when it’s appropriate to use the WCB payment program. It is an offence under the Workplace Safety and Insurance Act (WSIA) for anyone to make a false or misleading statement to the WSIB.

Ask the patient if the injury/illness happened at or as a result of work. The response is:
Ask the patient if they have or intend to claim WSIB benefits. The response is:

Answer

Bill MOHLTC

Answer

  1. Bill the MOHLTC for insured services using the MOHLTC Schedule of Benefits and the WCB payment program. For example, use the code A001 for minor assessment or A007 for intermediate assessment. The WSIB and the MOHLTC have a billing agreement in place and joint MOH/WSIB audits occur periodically.
  2. After the patient’s first visit, complete and submit the appropriate Health Professional’s Report (e.g. Form 8) to the WSIB.

Answer

The OMA has set out guidelines for physicians to follow in the Physician’s Guide for Uninsured Services (January 2017 ed. p.26 – “physicians must, a) respect their patient’s request and not report the injury to WSIB, but b) refuse to bill their medical services to OHIP”) .  You can direct your patient to the WSIB’s What workers should know about reporting workplace injuries and illnesses fact sheet on our website.