SpesNews Volume 118
Medical Doctors Coding Manual (MDCM)
The South African Medical Association (SAMA) previously availed the printed form of the Doctor’s Billing Manual (DBM) up until the 2009 edition. Since then, only an electronic version has been available in the form of the eMDCM. The 2015 edition is now available in printed form and can be ordered from the SAMA website at the following address:https://www.samedical.org/products/mdcm
The 2015 book format incorporates all the code interpretations with their code references as well as all changes and updates from 2009 onwards. There are also separate sections for the Road Accident Fund (RAF) and the Compensation Fund. Furthermore it also contains the current scope of practice of medical doctors. Referencing the SAMA website, for SAMA members, the first copy of the book will set you back R675 and subsequent copies for SAMA as well as non-SAMA members are priced at R1 255 each.
It is extremely important that your practice management and claims submission systems adhere to these and, where possible, incorporate as much as possible of the MDCM rules and guidelines to avoid medical scheme forensic audits. In addition to a functional knowledge of these codes and modifiers, competent claims submission systems just provides an added layer of protection in the armamentarium of the highly targeted and regulated private healthcare environment while assisting the practice to optimise the practice income.
CMS SCRIPT 5 of 2015 (rehabilitation)
The Council for Medical Schemes published CMS script 5 of 2015 pertaining to rehabilitation of PMB conditions. Conditions that may require rehabilitation include the following:
Brain disorders, Chronic Pain due to Cancer, Major bone or joint surgery, severe Rheumatoid Arthritis, post-M.I and stroke patients, Spinal Cord Injuries, Major Trauma and non-progressive neurological diseases.
Assessment for Rehabilitation would be subject to evaluation by a multidisciplinary team in conjunction with a Functional Independence Measurement score. The Office of the Registrar implemented a directive that rehabilitation should be funded while an improvement in functionality can be illustrated. All healthcare providers involved in the rehabilitation are expected to submit an initial clinical assessment alongside a treatment plan, desired goals and an estimate on the duration of the treatment. Regular progress reports are often also required for the duration of the treatment. The full script is available at:
National Health Act (NHA)
With the multitude of articles relating to the POPI Act currently dominating headlines, practices are reminded of the following within the NHA:
The person in charge of a health establishment in possession of a user's health records must set up control measures to prevent unauthorised access to those records and to the storage facility in which, or system by which, records are kept.
Any person who:
(a) fails to perform a duty imposed on them in terms of subsection (1);
(b) falsifies any record by adding to or deleting or changing any information contained in that record;
(c) creates, changes or destroys a record without authority to do so;
(d) fails to create or change a record when properly required to do so;
(e) provides false information with the intent that it be included in a record:
(f) without authority, copies any part of a record;
(g) without authority connects the personal identification elements of a user's record with any element of that record that concerns the user's condition, treatment or history;
(h) gains unauthorised access to a record or record-keeping system, including intercepting information being transmitted from one person, or one part of a record-keeping system, to another;
(i) without authority, connects any part of a computer or other electronic system on which records are kept to-
(i) any other computer or other electronic system; or
(ii) any terminal or other installation connected to or forming part of any other computer or other electronic system; or
(j) without authority, modifies or impairs the operation of-
(i) any part of the operating system of a computer or other electronic system on which a user's records are kept; or
(ii) any part of the programme used to record, store, retrieve or display information on a computer or other electronic system on which a user's records are kept,
commits an offence and is liable on conviction to a fine or to imprisonment for a period not exceeding one year or to both a fine and such imprisonment. Ultimately, a healthcare professional assumes responsibility for the actions of his personnel as well as for the integrity and functionality of the claims submission and process management systems that are employed in the practice. Please ensure that these do not expose the practice to unnecessary risk – here data integrity, accuracy, access limitation and protection against unauthorised access would be paramount.
Government project Ku-Riha
Ku-Riha is a Xitsonga word for compensation and is the name of a project being implemented by the Medical Bureau for Occupational Diseases and the Compensation Commission for Occupational Diseases (CCOD) of the Department of Health. It was launched in an effort to speed up compensation to current as well as former mine workers who have submitted valid compensation claims and is the culmination of an initiative from the government in collaboration with 8 mining or former mining companies. Already more than 100 000 such cases have been identified. These include diseases such as TB, asbestosis, lung cancer and silicosis. Around R1.5-billion has been set aside to go towards compensation to workers. Practices treating patients with these occupational afflictions should please take notice of this project.
For more info, please click on the following link.