SpesNews Volume 126
SpesNet Membership options
Please take note that the SpesNet membership fees for 2016 are:
Plan 2 – R550
Plan 3 – R720
2016 is going to be a big year with new and exciting products and enhancements on offer to our valued clients.
National Health Insurance (NHI)
The widely anticipated NHI White Paper has finally been released. The document can be obtained by clicking on the following link to the SpesNet website:
The document contains vital information on the NHI rational as well as the roll-out process outlined over 10 chapters:
Chapter 1: Introduction and Background
Chapter 2: Definitions, Features and Principles of NHI
Chapter 3: Problem Statement
Chapter 4: Rationale and Benefits of NHI
Chapter 5: NHI coverage
Chapter 6: Healthcare System and Service Organisation under NHI
Chapter 7: Financing of the NHI
Chapter 8: Purchasing of Healthcare services
Chapter 9: Phased Implementation
Chapter 10: Conclusion
The Provider Payment mechanisms, NHI Information Systems and the future role of medical schemes are discussed in chapter 8 and the contracting of accredited specialist services in chapter 9. Chapter 7 specifically deals with public funding models available to finance the NHI. SpesNet highly recommends that all practitioners download and read the document through thoroughly to get a solid understanding of the principles around the proposed NHI model.
Competition Commission Inquiry (CCI)
The submission of the findings of the CCI into the private healthcare sector is not expected before December 2016. While all attempts have been made to have this wrapped up by November 2015, the extent of the inquiry forced this extension of deadline. Public hearings is scheduled to kick off on 1 April 2016 and should reach conclusion by 31 May 2016.
Year End Checklist
With the deadline for the submission of the section 51 PAIA manual now extended by another 5 years, the following aspects become more important with the end of 2015 rapidly approaching:
Practice Operating Hours
Please ensure this is communicated clearly to patients and other medical professionals who might be referring to you. If a practice will be closed, alternative patient management or arrangements should be made (locums or referrals to a hospital or another medical specialist) and clearly conveyed.
Practice Management Systems
Your practice management system should be updated with the appropriate 2016 tariffs in time for the new year. This will ensure that the correct fees (and co-payments) are levied from the patients (naturally after the mandatory consent has been obtained). For VeriClaim users, this process is completely automated and no action is required from the practice’s side.
Practice Billing Policy
December is a great time to re-evaluate the current practice billing policy. With medical scheme increases roughly between 5% and 10%, your claims management system should be able to show its versatility and efficiency to accommodate your updated billing policy.
Specialists are encourage to compile their CEU documentation as an increase in CEU audits from the HPCSA is expected. Currently 30 CEU points should be accumulated on an annual basis, 5 of which should be on ethics, human rights and medical law. All CEU points should be kept updated and all supporting documents (usually certificates) should be kept on file.
Should your practice be subject to a HPCSA CPD audit, the CPD 1 IAR form (downloadable from here) should be completed and submitted (together with the supporting documentation) to the HPCSA via
Mail: The CPD Officer, HPCSA, P O Box 205, PRETORIA, 0001
Fax: to 012 3285120
DUXAH - The DUX Academy of Healthcare
DUXAH, the SpesNet Training Academy, is focused on the training of healthcare administrators, undergraduate students, registrars as well as healthcare professionals across a wide range of programmes and topics. Currently the following online modules and certificates are available for healthcare administrators:
HEALTHCARE ADMINISTRATION MANAGEMENT CERTIFICATES:
- Administration Management
- Healthcare Management
- Business Management
For a limited time only, DUXAH will be offering these certificates at 2015 rates exclusively for SpesNet practices registering their staff prior to 31 January 2016. For more information, please contact DUXAH on 012 110 4172 or at firstname.lastname@example.org.
SpesNet would like to confirm that reimbursement for the treatment for PMB conditions still remains subject to the provisions within the Medical Schemes Act and regulations to the Act. The Act stipulates that involuntary non-DSP providers should be reimbursed at cost. DSP providers are reimbursed at the contracted rate. Rumors that the treatment for PMB conditions are reimbursed at 300% still remains unsubstantiated at this point and SpesNet would caution against reliance on this type of communication. SpesNet would highly recommend that, where alleged, proof of this type of reimbursement is requested. If it is the case, the 300% reimbursement should be across the board and not merely isolated claims that could be attributed to involuntary non-DSP type of scenarios. Any decision made in the practice should always be based on fact and confirmation.
SpesNet Year End Wishes
SpesNet would like to take this opportunity to wish all practices a safe and blessed Christmas and a prosperous 2016. This is the time to reflect on the past year, spend time with the loved ones and assess where practice and business processes could be improved