• 14 Oct 2015

    SpesNews Volume 122

    BONITAS STANDARD OPTION

    Practices should please note that all payments on the Bonitas Standard Option has been postponed due to a technical administrative error until further notice. The problem is currently being addressed by MedScheme and will be resolved as soon as possible.

    This error only affect certain claims and is not an indication the Medscheme system’s ability to assess and pay claims, nor does it reflect on the ability of Bonitas Medical Scheme to honour claims or it financial stability. SpesNet would recommend that patients on this option be treated as cash patients until further notice.

     

    COMMED ROOTS OPTION

    Enablemed has communicated that it is presently not able to make payments as Commed is withholding the premiums to pay claims. Enablemed will also be unable to authorise services to patients.

    Enabledmed and Commed are said to be in the process of negotiations through the appropriate regulatory bodies and contractual provisions in an attempt to have the issues resolved.

    SpesNet would also recommend that patients on this option be considered and treated as cash patients until such time as the administrator-scheme problems have been addressed.

     

    PRACTICE NUMBER INFORMATION

    “The PCN System is administered by BHF in accordance to regulations 1 and 5 of the Medical Schemes Act (Act 131 of 1998). Section 59(1) (e) of the Act stipulates that service providers must include their practice code number in the account or statement.”

    In terms of regulation 5 section 59 (1) of the act, a practice number is compulsory and without it, medical schemes are at liberty to refuse scheme payments.

    Outstanding balances can be obtained from:

    http://www.pcns.co.za/pcns-statements-and-online-payment

     

    LOW-COST BENEFIT OPTION (LCBO)

    The Council for Medical Schemes published the mandatory requirements medical schemes would have to observe if they want to offer a cheap, benefit-limited version of current available options. A low-cost benefit option will not provide cover for the prescribed minimum benefits, nor will it provide cover for care in private hospitals. In a bid to reach the potential 15 million employed but uninsured workers, the LCBO will be focussed on preventative, primary healthcare.

    The LCBO will be available only to people who earn less than the tax threshold and will be offered only by registered medical schemes. This move enforces government’s plan to tighten regulation oversight of health insurance, GAP cover and hospital cash plans. In the practice it thus becomes even more important to note what type of medical scheme option a patient is registered on in order to limit occurrences of non-payments due to patients on the low cost benefit options

     

    HPCSA ROADSHOW

    While all topics featured at the 2015 HPCSA Roadshow were important, the 3 immediately affecting the most practices would definitely be that patients has to be aware of the cost of services beforehand (in rands), practices must implement and maintain of a consistent billing policy and the communication of the envisaged incorporation of CEU points assessment in the annual HPCSA registration process.

    All of these are already addressed via DUXAH (the DUX Academy of Healthcare for CEU workshops and conferences – www.duxah.co.za) and VeriClaim (electronic claims submission and optimisation system - www.vericlaim.co.za).

    Other topics covered included the Legal and Disciplinary processes, Professional Boards overview and the HPCSA comment regarding the matter of Assisted Suicide. Informed Consent and Ethical Guidelines and Dilemmas deserved a slot on its own and practitioner non-compliance accounted for almost half of all complaints since the beginning of 2015.

     

    NEW HELPLINE NUMBER (012 683 0340)

    Please note that the following number should be used for all helpline queries:

    (012-683 0340)

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EthiQal is a comprehensive Medical Indemnity solution developed for South African Medical Practitioners by Constantia Insurance Company Limited. Local risk assessment based on South African private sector settlements only. Specialty focused support and inputs to practice management. Provision of Occurrence and Claims Made insurance cover. Insurance contracts which are enforceable in terms of South African law and Regulations.

DUXAH, The DUX Academy of Healthcare, evolved from within SpesNet, a company established by medical specialists to assist medical specialists and recently qualified registrars to negotiate the fraught business of private practice.

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