The recently announced two-year pilot program allows Ontario doctors to bill up to $450 per month for patient engagements conducted via secure messaging. Ocean Patient Messages is an approved vendor solution under this program. As a result, some Ocean users may find this program to be beneficial. 

Here’s how we understand the program so far—for official details and registration, please site the Ontario Health website.

About Ontario’s new Secure Messaging fee code: K303A

What is the new K303A fee code?

The Ontario Ministry of Health is conducting a two-year Secure Messaging Proof-of-Concept (PoC) Pilot within the Ontario Virtual Care Program (OVCP), as per the 2021 Physician Services Agreement with the Ontario Medical Association. This pilot, running from April 1, 2024, to March 31, 2026, aims to enhance patient-to-physician care via secure messaging, which is not covered under the Ontario Health Insurance Plan (OHIP).

Who can apply to K303A?

Physicians interested in integrating secure messaging services in their practice must register individually by July 31, 2024, through Ontariohealth.ca. Participation involves adhering to the pilot’s terms and conditions and submitting claims for publicly funded, eligible uninsured services delivered via secure messaging.

What are the requirements for K303A?

Physicians must use a secure messaging-capable virtual visit solution verified by Ontario Health and listed on the Verified Solution List (ie. Ocean).

How do I register to join the K303A pilot program?

Physicians need to register individually, which takes about 30 minutes. Registration page is here: https://www.ontariohealth.ca/secure-messaging-proof-concept-pilot

What are the benefits of K303A for Ontario physicians?

Once the physician’s registration has been processed and approved, they will be able to submit a new fee code (K303A) to OHIP to cover “Secure messaging service encounters”. The value of the full Monthly Management Fee for these codes will range between $150 – $450 per month based on how often the services are provided.

The claims system counts the number of approved K303A services rendered by the physician each month, and allocates the physician to one of the Monthly Management Fee payment tiers per below:

• Tier 1: Min 15 K303A services – $150 per service month
• Tier 2: Min 30 K303A services – $300 per service month
• Tier 3: Min 45 K303A services – $450 per service month

It is important to note that for physicians on a blended capitation model, payments will be at the shadow billing rate of the group regardless of the enrolment status of the patient (if applicable for that model) to whom the K303A is delivered. A full explanation of the billing details can be found here.

Which patient engagements qualify for K303A?

According to Ontario Health, secure messaging service encounters must include: an exchange of secure messages, transmitted between a patient or patient’s representative and a physician, encompassing all messages that were exchanged to undertake and complete the clinical service for the presenting health issue(s), which includes the physician soliciting the appropriate patient information, analyzing the information, and providing appropriate management and/or advice related to the patient’s presenting health issue(s).

Also note, the K303A fee code can ONLY be applied in the case of an existing physician/patient relationship (please refer to Ontario Health for specific requirements, but generally speaking it means the doctor has engaged with the patient and billed a related OHIP service in the past 24 months).

See below for more specific details about what qualifies:

• Secure messaging service encounters require that, in the physicians’ professional opinion in accordance with accepted professional standards and practice, the patient’s care and support requirements can be effectively and appropriately delivered by secure messaging.
• Secure messaging service encounters must be either: 1) initiated by the patient, or the patient’s representative; or 2) initiated by the physician as a clinically appropriate follow-up to a preceding service initiated by the patient or the patient’s representative.
• Secure messaging service encounters must include the physician soliciting the appropriate patient information, analyzing the information, and providing appropriate management and/or advice related to the patient’s presenting health issue(s).

Which patient engagements DO NOT qualify for K303A?

While not a comprehensive list, below are some examples of services that would not qualify for the K303A fee code according to Ontario Health:

• Administrative encounters (such as, scheduling request, request for medical records, update on status of a referral)
• One-way dissemination of information (such as, sending test results, notification of vaccination clinics)
• Patient sends additional/missing information or seeks clarification from a previous service
• Patient sends an update from a service with another health care provider
• Patient requests a doctor’s note
• Patient requests a prescription renewal, and it is not necessary to solicit information, analyze and provide management and/or advice to address the request.