This guide provides recommendations to help physicians document time-based FHO+ hourly rate activities with step-by-step EMR instructions for Avaros EMR.

Effective April 1, 2026, a new hourly rate will compensate FHO physicians for time spent on direct and indirect patient care, as well as clinical administrative work.

Contents

1.  Review and update your roster in your EMR

2.  Understand how to identify rostered patients in your EMR

3.  Create a Designated “Tracking” Patient

4.  Create a recurring daily appointment as a reminder

5. i) Record daily hours and activities in a structured encounter note

    ii)steps to create insert a template into your note (Sample Template Included)

6.  Billing codes are already added to your EMR

7.  Create an Invoice for each date of service

8.  Monitor billing hours to stay within required limits

Review and Update Your Roster in Your EMR

Reviewing your roster helps keep your patient panel accurate and up to date.

Why this matters

Time-based activities apply only to care provided to FHO rostered patients. Maintaining an accurate roster helps distinguish care provided to rostered versus non-rostered patients.

When to do this

It is recommended that you review your roster monthly when the MOH sends you the report. Using the provided roster reconciliation tools and processing the files regularly ensures updates are quick and manageable.

How to do this

In Avaros, roster reconciliation can be done by running this report in the EMR when it is received at the beginning of each month from the MOH.

1. In the Schedule Dashboard → Click 'Administration';
2. Click ‘Billing’ and then navigate to 'MCEDT Mailbox';
3. Click on the 'Download' folder of the 'MCEDT Mailbox'; 
4. Select the doctor whose report you would like to run individually from the drop-down menu.
5. Hit the 'Load Page' button;                                                          
6. Select the check boxes of the Roster Reports then scroll down and click the 'Download' button;

7. Once the File is downloaded, it will appear in the 'View MOH Files' tab. In 'View MOH Files', click on the file name of the Roster xml file to run the report and automatically synchronize the MOH roster list for that provider with your Avaros Roster list and update the roster status for all patients.

We have a video walkthrough available on how to manage all MOH file types available, including RO reports, if you would prefer to see how to complete this task step by step – MOH Billing Guide: Submission and Reconciliation

Understand How to Identify Rostered Patients in Your EMR

Know how Avaros displays rostered versus non-rostered patients. Indicators in Avaros are available in both the Master Record and the Schedule.

Indicators available in Avaros

Master record: You can find this status under the Clinic Status section in a patient’s master record along with the enrollment date and provider.

eChart: The Roster status and enrolled provider will automatically show at the top of the eChart display

Invoice: The Roster status and enrolled provider will automatically show at the top of your invoice display so you know their status as you are billing for the patient.

Schedule: You can turn on the ability to see rostered status directly in a booked appointment. This must be turned on as a setup step for each doctor. To turn this on you will need to:

• Navigate to your schedule settings indicated as a gear icon in the top right corner of your schedule
• Select Schedule preferences
• Search and select your name from the drop-down menu in the top right corner
• Toggle the option to “See MRP and Roster Status” to “On”
• Select “Update” to save your changes.

Why this matters

Understanding how Avaros identifies roster status helps with identifying and tracking FHO+ hourly rate hours and activities only for eligible (rostered) patients.

Create a Designated “Tracking” Patient

Create a designated “tracking” patient in Avaros to document your daily hours and activities. It can also be used to submit FHO+ hourly rate billing. This “tracking patient” contains no real patient information and may be set up by staff.

Why this matters

• Establishes a consistent place to document your daily hours and activities.
• Allows you to follow a familiar workflow: open chart → create note → document.
• Keeps all documentation EMR-first and audit ready.

When to do this

Set up this tracking patient once at the start as part of preparing your FHO+ hourly rate documentation workflow. After setup, this tracking patient will be used every day to record your hours and activities. 

Helpful tools

• Name the tracking patient clearly and meaningfully (e.g., “Smith – FHO+ Hourly Rate”).
• If multiple physicians share one EMR, include the physician’s name or initials in the tracking patient’s name to keep charts separate.
• Create one tracking patient per clinician who will bill the hourly rate.
• This tracking patient may later be used to submit the hourly rate billing claims.

How to Create a New Tracking Patient

There are 3 ways to create a new demographic for them:

1. Creating a demographic from the ‘Search Patient’ menu option
2. Creating a demographic from the ‘Search Demographic’ bar
3. Creating a demographic from the ‘Create Appointment’ window

In each of these methods, there is a patient search bar in which you can type in the patient's information (Name, DOB, Health card number). After running your search, if there is no existing patient matching the search term, select ‘Create demographic’.

This open’s the ‘Create Demographic’ window in which you can fill out the remainder of the patient’s information. Select ‘Create’ to finish and add the new demographic.

Note: You can enter a fakes date for the date of birth and assign any patient sex to this tracking patient. This information gets removed when submitting FHO+ invoices to the MOH.

Create a Recurring Daily Appointment as a Reminder

Schedule a recurring end-of-day appointment for the designated tracking patient. This serves as a reminder to calculate and document your daily FHO+ hourly rate time-based activities and hours. Staff can assist with setting up this recurring appointment.

Why this matters

• Acts as a reminder to integrate time tracking and documentation into the daily workflow.
• Reduces the risk of missed or forgotten hours.
• Encourages adherence to consistently track FHO+ hourly rate time and activities.
• Allocates flexible time in the EMR schedule for end-of-day documentation.

When to do this

• Set up the recurring appointment at the start of the month, or as early as possible, to avoid conflicts.
• Schedule the appointment at the end of the day, after the last booked patient, to avoid double-booking.
• Booking the appointment for every day of the month can help capture all eligible hours.
• Consider using a distinct appointment type or colour coding to make it easily identifiable.

Creating recurring appointments in Avaros

1. Begin by double clicking into your schedule in the time slot where you would like the appointments to show. This will open up the “Create Appointment” window.

2. Search and select your FHO+ tracking patient from the demographic search bar.

3. Click the “customize” button in the recurring appointment field.

4. Set your recurring appointments to occur on a daily basis. Select “Done” when finished.

5. Finish your booking by selecting the “Create Recurring” at the bottom of the window.

Note: If this appointment conflicts with other booked appointments, it may create a double booking in the schedule.

Record Daily Hours and Activities in a Structured Encounter Note

Each day, use the provided structured encounter note template for your tracking patient to record your daily FHO+ hourly-rate time and activities for the work performed that day. This ensures that time spent on each eligible category is documented consistently and that supporting details are available if requested for audit purposes.

• In the encounter note template, enter the total time spent providing Direct Care, Direct Phone Care, Indirect Care, and Clinical Administration for that day.
• Document the activities performed for Indirect Care and Clinical Administration.
• Record any Direct Care provided (e.g., in-person, virtual, or phone care) in your schedule for audit purposes.

Why this matters

• Ensures accurate documentation of actual time spent on Direct Care, Direct Phone Care, Indirect Care and Clinical Administration.
• Demonstrates the work performed for claimed Indirect and Clinical Administration hours if requested by the Ministry of Health (MOH).
• EMR audit and security reports may not provide a full picture of daily activities. Using the daily note template ensures a complete record, including work performed outside the EMR.

When to do this

• Physicians are required to enter a daily record each day for the work performed (including time spent and activities, as applicable).
• The hourly rate is billed in 15-minute units, calculated cumulatively across the day. Any remainder of eight (8) minutes or more is rounded up to a full 15-minute unit.
• Start and stop times do not need to be recorded for activities.
• Activities do not need to be recorded on a patient-by-patient basis.
• Refer to the OMA FHO+ hourly rate reference guide for more information.

Adding a Note in the Patient Chart

To open the tracking patient’s eChart and add a note:

1. Click the ‘E’ button beside the tracking patient’s name on the schedule, or search for the tracking patient in the demographic search bar and click ‘E.’

2. In the eChart, click the ‘+ New Note’ button in the encounter note section to create a new note.

3. Enter free text or insert a template to document your daily hours and activities.

Steps to Insert a Template

1. In the eChart encounter note section, type in the “@” symbol which will open up your template library.

2. Type the name of your template (e.g., “FHO+ Hourly Rate”).

3. Select the template from the list to insert it into the encounter note.

4. Fill in the hours and select the applicable activities.

5. Click “Submit” when finished to save your note.

Creating Templates in Avaros

Avaros allows you to create encounter note templates with placeholders, selectable fields, and automated measurements. Templates can be created or customized using the sample template provided below.

→ eChart → Open a Note → Templates → Create Template

Avaros Template Sample

Copy and paste the sample template below into the template editor and customize it to fit your workflow.

1) Direct Care Hours: ___

2) Direct Care Telephone Out of Office Hours: ___

3) Indirect Care Hours: ___

4) Clinical Administration Time Hours: ___

Indirect Activities (Select those that apply):

[ ] Paperwork (e.g. charting/documentation; preparing referrals and requisitions; completing clinical forms, reports and medical certificates of death, excluding third-party requests)

[ ] Coordinating and planning care (e.g. chart reviews; reviewing results such as labs, imaging, consult notes)

[ ] Conferencing, consulting and meeting with other physicians and healthcare professionals for a specific patient or patients

[ ] Conferencing and meeting with family members and/or patient medical representatives

[ ] Discussion with, and providing advice and information to the patient or representative via synchronous or asynchronous care communication

[ ] Reviewing clinical information or research directly related to a particular patient

[ ] Patient-specific clinical teaching arising from direct patient care

[ ] Other (insert details):

Clinical Administration Time Activities (Select those that apply):

[ ] Proactive patient management (e.g. screenings, chronic disease)

[ ] EMR updates requiring patient expertise

[ ] Quality improvement initiatives

[ ] Other (insert details):

The Billing Codes are Already Added to Your EMR

The new billing codes will automatically be added into your EMR. You do not need to add them on your own.

Create an Invoice for Each Date of Service

Billing for the hourly rate follows the same process used for CME or the preventive care annual bonus. Record your daily FHO+ hourly rate bills using the tracking patient.

To create an invoice in Avaros

1. From the tracking patient’s booked appointment in your schedule, select the “B” button to open up a blank invoice.

2. Change the Billing Type from ‘Bill OHIP’ to ‘FHO+.’ This ensures patient information is excluded and the claim can be processed.

3. Set the Service Date to the relevant date of service. The date will auto-populate to the date of the appointment by default.

4. Search and add the appropriate Service Codes (Q310A, Q311A, Q312A, Q313A) each as a line item in your invoice. You can select codes from the billing form or manually enter them.

5. Adjust the quantity for each Service Code to reflect the hours being submitted (15 minutes = 1 time unit). Delete any service codes not applicable, as they cannot be set to a quantity of 0.

6. Click ‘Save’ when finished, or continue adding claims for additional dates.

Add the FHO+ Codes to your Billing Form for a Quick Select Option

Consider adding the FHO+ hourly rate codes to your billing form for quicker selection when creating invoices.

1. Select the gear icon in the top right corner of your invoice to open up your billing settings.

2. Navigate to the “Billing Form” section of your settings and select the billing form you would like to add the FHO+ service codes to.

3. Add each of the FHO+ service codes to one of the 3 columns in your billing form.

4. Select “Update” when finished to save your changes. The codes will now appear when your billing form is selected in the invoice view.

Monitor Billing Hours to Stay Within Required Limits

Track your daily hours to stay within allowable daily and monthly billing limits. This helps you keep an accurate record, monitor your hours, and avoid rejected claims.

This can be done using the FHO+ Calculator on the OMA website linked here.

Why this matters

• Physicians must adhere to billing limits to avoid claim rejections or overpayments.
• The OHIP system will reject claims that exceed the 14-hour daily limit or the prorated monthly limit of 240 hours.

    Physicians are responsible for staying within the percentage caps:

• CAT = 5% of Indirect + Direct
• Indirect + CAT = 25% of Direct
• As of April 1, 2026, only absolute hour caps (14/day, 240/month) will be in place. The Ministry of Health will reject billings over these amounts.
• As of April 1, 2026, the percentage caps will NOT be in place. If a physician submits hours exceeding these caps, payment for the extra hours will be adjusted at a future date (to be determined).

When to do this

• Daily or weekly, enter the daily hours recorded in the tracking patient from Avaros into the FHO+ Calculator, with each day entered separately.
• Work month-by-month in the FHO+ Calculator and clear data between periods to avoid confusion.
• Staff can assist with transposing hours from Avaros into the calculator as needed.
• The calculator is optional and is meant only to complement the required daily documentation (maintained in the EMR as recommended). Physicians can use it to monitor ongoing totals and alignment with billing limits by transposing cumulative hours from the EMR.

Note: The FHO+ calculator does not replace EMR documentation and does not capture FHO+ hourly rate care category activities for audit purposes.

For further assistance, contact OntarioMD at 1-866-744-8668 or support@ontariomd.com

For Avaros-specific support, contact Avaros at support@avaros.ca