OHIP Billing Automation for FHO+ Claims

HYPEMedical_FHO is an OHIP billing automation module that helps identify eligible rostered services, calculate and document the associated FHO+ minutes, and prepare a physician’s daily hourly-rate claim. HYPEMedical_FHO can also be used as a productivity tool by users of third party billing and EMR software.

Prepare an FHO+ Claim

1. Select the physician’s FHO+ profile by going to:

   Doctors → Doctor Profiles → Setup
   

2. Open the physician’s profile and select:

   Edit Doctor Profile → HYPEMedical FHO

3. Click FHO+ Minutes to Claim Converter.
   
   
4. Select a date containing rostered claims. Eligible dates are highlighted in green.
   
5. Click Find Rostered Services.
6. Review the identified services and calculated minutes.
7. Click Prepare FHO Claim.
   
   
   
8. Create the prepared claim.
9. When saving the claim, click Save Claim Anyways. This allows HYPEMedical to save the hourly-rate claim even though regular patient demographic information is intentionally missing.
   

Tip: Create a Fictitious Patient Record

When creating your first FHO+ hourly-rate claim, create a fictitious patient record using:

Last Name: Hourly
First Name: Rates

For future FHO+ hourly-rate claims, search for Hourly Rates and reuse the same fictitious patient record.

Troubleshooting

No dates are highlighted in green

Confirm that:

• The physician’s claims have been entered for the required service period.
• The roster information for the applicable month has been imported.
• The correct physician profile is open.
• The claims are associated with patients identified as rostered.

Expected services are missing

Confirm that:

• The patient was identified as rostered for the applicable period.
• The service code has been configured in the physician’s HYPEMedical_FHO settings.
• The service date and billing physician are correct.
• The claim was not rejected, deleted, reversed, or entered under another physician.
• The service is eligible under the applicable FHO+ billing rules.

The system will not save the claim

Confirm that the Hourly Rates patient record is selected.

When the missing-demographics warning appears, click:

Save Claim Anyways

The calculated minutes do not look correct

Review the physician’s FHO+ service-code settings, including:

• Assigned minutes
• Direct or telephone-care classification
• Applicable Q310–Q313 category
• Daily and monthly limits
• Previously prepared or claimed services

Do not submit the claim until the calculation has been reviewed and approved.

Important Billing Reminder

The physician or authorized billing representative remains responsible for confirming that:

• The underlying services were provided.
• The patients were eligible and rostered for the applicable period.
• The assigned minutes accurately reflect the work performed.
• The prepared claim complies with current OHIP and FHO+ payment rules.
• The final claim is reviewed before submission.