The ministry and the OMA agreed that a portion of the Preventive Care Bonus for FHN and FHO physicians will be repurposed. The financial results achieved will be repurposed to create an Acuity Modified based capitation payment to physicians based on enrolled patient complexity.
For further information on the Acuity Modifier please see INFOBulletin 240502 – “Acuity Modifier Payment for the 2024-2025 Fiscal Year”. As a reminder, no action is required on the part of the physician or physician groups for acuity modified based capitation payments to take effect.
2024/2025 Preventive Care Bonus for FHN and FHO physicians
For fiscal year 2024 (April 1, 2024 to March 31, 2025) and billable April 1, 2025 onwards, FHN and FHO physicians will no longer be eligible to receive the Colorectal Cancer, Mammography, and Pap Smear Preventive Care bonuses, as agreed upon between the ministry and the OMA. They will continue to be eligible to receive the Influenza and Childhood Immunization bonuses with these adjustments:
- Physicians with less than 1000 enrolled patients will have the remaining bonuses prorated.
- Physicians with 1000 enrolled patients or more, will not have the remaining two bonuses prorated, and will bill per status quo.
Proration
Starting with the 2024/2025 fiscal year preventive care bonuses, FHN and FHO physicians with less than 1000 enrolled patients on March 31st of the fiscal year will have the Childhood Immunizations and Influenza bonuses prorated based on the following formula:
(Number of patients / 1000) X amount of bonus = prorated bonus amount
For example, a FHO physician with a roster size of 575 patients and a 75% compliance rate for the Influenza vaccine is eligible for a $633 bonus:
(575/1000) X $1100 = $633.00
Error messages
For the 2024/2025 fiscal year and beyond, physicians who bill fee schedule codes for bonus categories they are no longer eligible for will have the claims reject to their Error Report with the following message: ‘EPA – Network Billing Not Approved’. See list below for Preventive Care bonus fee schedule codes.
For more information, click here.
