Why can I not just compare my numbers to other physicians?

Because billing is not discussed between colleagues in this market, so the comparison data does not exist in any reliable form. The figures that do circulate are usually gross billings rather than collected revenue, from a different practice structure, and without a stated definition. A hospital-based specialist and a community practice have different cost bases and different code mixes, so the comparison would be misleading even if the numbers were accurate.

What is a first-pass acceptance rate and why does it matter?

It is the share of claims paid on first submission without rejection or adjustment. It matters because it is the one metric that captures administrative quality in a single number, and because the gap between a good rate and a poor one is money that was earned and never collected. It is calculated from your own remittance data, so it requires no benchmark to be useful.

Does feeling busy mean the practice is performing well?

No. Volume and collected revenue come apart in several ways: a full clinic with a high rejection rate, consultations downgraded to assessments on adjudication, premiums never claimed, or services submitted after the three-month window closed. A practice can be at capacity and collecting materially less than it earned, and nothing in the daily experience of the work signals it.

What should an Ontario specialist review monthly?

The error report, specifically the oldest unresolved item on it, because the three-month submission window runs from each date of service. Then collected revenue against the previous month and the same month last year, and the mix between base codes and premiums. Reviewing annually is too slow, because the submission window closes inside the gap.

How to Tell If Your Practice Is Performing Well

Q: How do I know if my medical practice is performing well?

Use signals from your own data over time rather than comparisons to other practices. The four that are available to any Ontario specialist without new systems are first-pass acceptance rate, the age of the oldest unresolved item on your error report, collected revenue per clinical day, and the share of your revenue arriving from premiums and modifiers rather than base codes. Each is a trend, so the useful question is which direction it is moving.

Most specialists assess their practice the same way: it feels busy, the clinic runs, patients are seen, money arrives. By that standard almost every practice is performing well, which is the problem with the standard.

The honest difficulty is that the obvious comparison is unavailable. Physicians in Ontario do not discuss billing with each other. The numbers that do circulate are gross billings rather than collected revenue, from a practice with a different structure, quoted without a definition. So the question has to be answered from your own data, over time, rather than against anyone else.

That turns out to be better anyway. A trend in your own numbers is a fact. A comparison to a half-remembered figure from a colleague is not.

Why busy and well are different things

Volume and collected revenue come apart in four specific ways, and none of them is visible from inside a working day.

A clinic can be full while a meaningful share of its claims are rejected and never followed up. It can be full while consultations are being adjudicated down to assessments. It can be full while premiums and modifiers the schedule allows are never claimed. And it can be full while services age past the three-month submission window because nobody read the error report.

In every one of those cases the work happened, the patient was cared for properly, and the revenue was incomplete. Nothing about the experience of the day tells you which is happening.

Four signals you already have

These come from data you already receive. None requires a new system.

First-pass acceptance rate. The share of claims paid on first submission with no rejection and no adjustment. This is the single most useful number in a practice, because it compresses administrative quality into one figure and needs no benchmark to be informative. If it is moving down, something changed.

The age of the oldest unresolved item on your error report. Not the count, the age. The three-month submission window runs from each individual date of service, so the oldest item is the one closest to being unrecoverable. A practice that tracks the count and ignores the age will lose the expensive items first.

Collected revenue per clinical day. Not per month, because month length and holidays move it around. Per clinical day, compared to the same period last year. This is the number that separates a genuinely busier practice from one that simply worked more days.

The share arriving from premiums and modifiers. Base codes are what gets submitted automatically. Premiums, modifiers and the listings that require a specific circumstance are what gets missed. A practice whose revenue is almost entirely base codes is usually not claiming everything the schedule allows for the work it is already doing.

Why annual review is too slow

A practice reviewing its numbers once a year, at tax time, is looking at a period in which every claim has already passed the three-month electronic submission window. The window was reduced from six months to three on 1 April 2023, which means the gap between an annual review and the deadline is now nine months of claims that can no longer be resubmitted electronically.

Monthly is the practical minimum, and the error report is the thing to read first. It is the only document that tells you about money you have earned and not yet been paid for, while there is still time to do something about it.

The uncomfortable part

The reason this question is hard to answer is not that the data is unavailable. It is that nobody in a physician's professional life is responsible for asking it. Clinical competence is examined, documented and peer-reviewed continuously. The business of the practice is examined by the physician, alone, using instinct, against no comparison, in time left over after the clinical work.

Confidence in that setting measures the absence of contradiction rather than the presence of evidence.

What a review actually does

A billing review works from your remittance and error report data and answers the four questions above with your own numbers. What is being rejected and why, what is being adjudicated down, what the schedule allows that you are not claiming, and how much of it is still inside the window.

It takes a conversation rather than a data handover, and it ends with a specific answer rather than a proposal. If your billing is in good shape, we will tell you that, and that is a useful thing to know with certainty rather than by assumption.

Start with a free OHIP billing review.

This article describes performance signals available from OHIP remittance and error report data. It is not accounting, tax or financial advice. Speak to your accountant about your own position.