1. Payment Integrity Program Independent Health Facilities Unit Presentation to IDCA Presented by: George Clarke Diagnostic Services & Planning Branch Date: September 20, 2013

2. 2 Independent Health Facilities Payment Integrity Program (IHFPI) Table of Contents IHFs – OverviewPage 3 BackgroundPage 4 GoalsPage 5 Monitoring Processes Page 6 EducationPage 7 CommunicationsPage 8 Questions / Comments / FeedbackPage 9

3. 3 Independent Health Facilities (IHFs) - Overview Ontario has approximately 935 Independent Health Facilities (IHFs) They provided 9.1million tests in 2011/12, a 4.3% increase over 2010/11 53% of all diagnostic services are performed in IHFs (among services for which they are licensed) in 2011/12. The largest category of services provided in IHFs are diagnostic radiology and ultrasound services Diagnostic ultrasound is the largest area of growth, increasing by 6% over last fiscal year 61% of all ultrasound and 71% of all sleep studies were performed by IHFs

4. 4 IHFPI Program - Background In 2012, the Office of the Auditor General of Ontario (OAGO) conducted an audit of the Independent Health Facilities (IHF) Unit. The audit recommended that the Ministry of Health and Long-Term Care (“the ministry”) periodically review IHF billing data to identify facilities with unusual billing patterns.

5. 5 IHFPI Program – Goals and Functions To review unusual billing practices, engaging the leadership community of IHFs in understanding the patterns that results in accountability practices consistent with provincial standards. The Program’s three principal functions are: Monitoring billing practices; Educating IHFs about acceptable billing practices; and, Communicating with targeted findings either to specific licencees or by sectors.

6. 6 IHFPI Program – Monitoring Processes Case management system will be created to: Allow for billing pattern analysis; Track status and outcomes of unusual billings; Fulfill the recommendation of the Provincial Auditor.

7. 7 IHFPI - Education Educational materials will be created that will instruct IHFs to ensure compliance with provincial billing standards Eg. Bulletin 2085- Schedule of Facilities Fees Preamble posted on February 12, 2013 To assist Independent Health Facility (IHF) licensees understand their obligations and requirements for submitting facility fee billings for processing and payment, the ministry has added preambles to each section of the Schedule of Facility Fees for Independent Health Facilities (Schedule)

8. 8 IHFPI - Communications Communication tools will be created for both specific cases or general sector communications Targeted letters to individual licencees regarding unusual billings Sector letters

9. 9 Questions / Comments / Feedback Comments / suggestions re program materials, points for discussion, etc.?