• 28 Oct 2015

    SpesNews Volume 123

    PAIA MANUAL

    As the 31 December 2015 deadline draw closer, SpesNet would like to once again remind practices of the PAIA section 51 manual that has to be completed and submitted to the SAHRC (South African Human Right Committee). A link to the template for this manual can be found here. Electronic submissions of the manual can be forwarded to:

    lidlamini@sahrc.org.za

    The physical documents must also be submitted to the SAHRC (even if an electronic record was submitted) at:

    Private Bag X2700
    Houghton, 
    2041

     

    BONITAS STANDARD OPTION

    Please note that the technical administrative error(s) that have caused all Bonitas Standard claims to be postponed, have now been resolved. Medscheme advises practices to be vigilant in their reconciliation of these claims and if you experience any problems or have queries, it should be directed to the Medscheme Call centre.

     

    MEDICAL RECORD RETENTION

    There have been a number of queries regarding the retention of medical records. The HPCSA regulations and guidelines stipulates:

    • Records should be kept for at least six years after they become dormant.
    • The records of minors should be kept until their 21st birthday.
    • The records of patients who are mentally impaired should be kept until the patient’s death.
    • Records pertaining to illness or accident arising from a person’s occupation should be kept for 20 years after treatment has ended.
    • Retention periods should be extended if there are reasons for doing so, such as when a patient has been exposed to conditions that might manifest in a slow-developing disease, such as asbestosis – the recommended period for keeping these records is at least 25 years.
    • The cost and space implications of keeping records indefinitely must be balanced against the possibility that records will be found useful in the defence of litigation or for academic or research purposes. The full HPCSA document is available here.

     

    CORRECTIONS IN VOL 122

    2 Errors in SpesNews Volume 122 have been pointed out.

    • Practices are informed that the administrator for Polmed Medical Scheme will be Medscheme (Pty) Limited and not Discovery as has been communicated through previously. This change will come into effect on 1 January 2016 and effectively means that Metropolitan Health will continue to function as the administrator of Polmed until 31 December 2015. The current Polmed payment arrangement will continue in its present form.
    • It was incorrectly reported in the recently published CMS report that Discovery Health had experienced a loss of membership. In fact, Discovery Health’s market share has consistently increased over the last several years and the inclusion of Bankmed from 1 January 2016, further consolidates their position as market leader.

     

    FORENSIC AUDITS on code 0147

    Some practices are currently being audited on their use of code 0147.

     

    Code         Description                                                                       

    0145         For a consultation/visit away from the doctor's home or

                     rooms (non-emergency):

                     ADD only to the consultation/visit items 0190-0192,

                     items 0173-0175,

                     items 0161- 0164 or

                     items 0166-0169, as appropriate.

                     Note: Only one of items 0145, 0146 or 0147 may

                     be charged and not combinations thereof.

                                                                                                                                                                                             

     0146        For an unscheduled emergency consultation/visit at

                     the doctors' home or rooms, all hours:

                     ADD only to the consultation/visit items 0190-0192,

                     items 0161-0164 or

                     items 0151-0153, as appropriate (refer to general rule B).

                     Note: Only one of items 0145, 0146 or 0147 may

                     be charged and not combinations thereof.

                                                                                                                     

    0147        For an emergency consultation/visit away from the

                    doctor's home or rooms, all hours:

                    ADD only to the consultation/visit items 0190-0192,

                    items 0173-0175, items

                    0161-0164, items 0166-0169 or

                    items 0151-0153, as appropriate.

                    Note: Only one of items 0145, 0146 or 0147 may be

                    charged and not combinations thereof.

     

    Emergency:

     “…the sudden and, at the time, unexpected onset of a health condition that requires immediate medical or surgical treatment, where failure to provide medical or surgical treatment would result in serious impairment to bodily functions or serious dysfunction of a body organ or part, or would place the person’s life in serious jeopardy.

    For more information on emergency treatment, please also refer to the CMscript 6 of 2012:

    https://www.medicalschemes.com/files/CMScript/CMScript6Of2012_2013.pdf

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