Amidst Tariff and Inflation Threats, Physician OHIP Billing is an Overlooked Goldmine
We can’t help but laugh when we speak with the doctors that are especially confident about their billing savvy. In our experience, the more sure you are that you’re billing to the best practice, the more you’re leaving on the table. Most Ontario doctors believe they’re billing OHIP correctly—but in our experience even the most experienced specialists are leaving hundreds of thousands of dollars unclaimed each year.
Just this month, we helped a highly confident ENT recover $200,000 in lost income, net of our fees, without any investment or risk on their part.
With inflation rising and tariffs cutting into buying power, doctors need to claim every dollar available to them. This blog explains why missed revenue is more common than you think and how to check if you're leaving money on the table.
1. Why Even Experienced Physicians Are Losing Revenue
Even the best doctors make costly OHIP billing mistakes because the system is complex, constantly changing, designed to favor the payer and is not easy to either understand or get feedback from.
1.1 OHIP Billing Rules Change Constantly
Fee codes, premiums, and exceptions are updated regularly, making it hard for busy physicians to keep up.
The difference between two similar codes can mean losing 10-30% of revenue per claim.
Worth noting: The MOH OHIP Bulletin Page gives updates on changes, and we post insights and our take here on this blog as well.
1.2 Manual Billing & EMRs Are Not Foolproof
Most doctors trust their EMR or admin staff to handle billing correctly, but EMRs don’t prevent underbilling.
Common mistakes: Not claiming applicable premiums, undercoding procedures, and missing retroactive claims.
Of all the free claims reviews and assessments we performed in 2024, over 90% of Ontario physicians have unclaimed billing errors within the past 12 months. For over 50% of these physicians, claims recovery above $50,000 has been possible.
1.3 Objection: “I Know I’m Billing Correctly”
An ENT we reviewed OHIP data for in February 2025 who recovered $200,000 in missed OHIP payments also thought they were doing everything right.
Our first clients, an Anesthesia physician and friend of ours, was completely convinced they were billing properly, and recovered well over $200,000 as well.
Typically the most experienced and confident doctors are the most shocked when we show them how much they’ve been underbilling.
2. How to Find Out If You're Losing Money (Risk-Free Check)
A free, no-obligation OHIP billing review can instantly reveal whether you're missing thousands in revenue.
If you know a doctor who is mentioning or complaining about cash flow challenges and isn’t sure what to do, tell them to get in touch with Physicians First.
2.1 The Simple Way to Check for Missing Revenue
A no-cost OHIP billing analysis runs your past claims through AI + expert review.
We compare your billing patterns against top-performing specialists in your field.
Error reports: The number of reports, number of errors in the reports, and number of pages will give you an idea. More than a few pages of errors, and it’s time for a clean up.
2.2 Common Areas Where Doctors Lose Money
Missed premiums: Rural premiums, after-hours fees, procedural add-ons.
Incorrect fee codes: Underbilling complex procedures, not bundling appropriately.
Unsubmitted claims: Rejected or forgotten claims that are still recoverable.
OHIP claims for many types of encounters can still be recovered within a 3 month window of the date of service. There are certain opportunities to appeal to OHIP for a 1-year manual review and recovery as well.
2.3 Objection: “If I Do a Review, Will It Cost Me Money?”
No. If we don’t find lost revenue, you pay nothing.
If we do find money, our fees are performance-based—meaning you only pay a percentage of what’s recovered.
3. Why Now Is the Best Time to Recover Revenue
With tariffs increasing costs and inflation reducing buying power, now is the time to maximize your income without working extra hours.
3.1 Inflation Is Lowering Physician Buying Power
Rising costs for medical supplies, technology, and staff salaries mean your income buys less today than it did last year.
Finding lost OHIP revenue helps offset these financial pressures.
3.2 OHIP Allows Retroactive Adjustments
Many missed claims and underbilled services can be recovered for up to 12 months.
The Ministry of Health allows claim resubmissions within a 12-month window under certain circumstances (MOH Billing Guide).
3.3 Objection: “I Don’t Have Time to Deal With This”
Our billing review is fully hands-off—we do all the work, and you just get a report with findings and insights that help you improve.
You’ll make more money without adding a single patient visit.
Conclusion
If you're an Ontario physician, there’s a high chance you’re leaving tens of thousands (or even hundreds of thousands) of dollars unclaimed in OHIP billing.
A free, no-risk review can show you exactly how much you’re owed—why not check today?
Q &A
How do I know if I’m underbilling OHIP? – A billing review can compare your claims to top-performing doctors in your specialty.
How much money do Ontario doctors typically lose in OHIP billing mistakes? – Many physicians miss between $50,000 and $200,000 annually.
Is there a fee for an OHIP billing review? – No, the review is free, and fees only apply if you recover lost revenue.
How does AI help with OHIP billing? – AI detects billing errors, uncovers missed premiums, and optimizes claims for higher payments.
What are the most common OHIP billing mistakes? – Missed premiums, undercoded procedures, and forgotten resubmissions.
How long can I go back to fix OHIP billing mistakes? – You can resubmit claims up to 12 months after the original submission date.
How does OHIP billing affect my overall income? – Optimized billing can increase net income by 10-30% without seeing more patients.
Why is inflation making it more important to check OHIP billing? – Costs are rising, so maximizing existing revenue is the best way to maintain buying power.
What percentage of doctors find errors in their billing after a review? – Over 70% of doctors discover missed income in their first review.
Can EMRs fully optimize my OHIP billing? – No, EMRs don’t automatically flag underbilling or missed premiums.
Why do even experienced doctors make OHIP billing mistakes? – The system is complex, and fee codes change regularly.
Can I do my own OHIP billing audit? – Yes, but a professional review is faster and more thorough.
What if I don’t find any lost revenue? – If there’s nothing to recover, you pay nothing—so it’s risk-free.
How does OHIP pay for different procedures? – Billing is based on fee codes, but additional premiums can often apply.
Why are some OHIP claims rejected? – Missing documentation, incorrect coding, or overlooked eligibility issues.
What’s the fastest way to recover OHIP billing mistakes? – A professional billing review can identify and correct errors quickly.
Are Ontario doctors overworked due to billing complexity? – Many are, which is why billing automation is so valuable.
Can OHIP reviews be done remotely? – Yes, most billing audits can be completed digitally.
How do I request an OHIP billing review? – Contact a professional OHIP billing service for a no-obligation review.
How much more money can I make by optimizing my OHIP billing? – Many doctors increase their net income by $100,000+ per year.
