2025 Medinol Tariffs and Rates
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Chronic Disease Abbreviations
Abbreviations for CDL (Chronic Disease List) conditions:
ADS – Addison’s Disease
AST – Asthma
BCE – Bronchiectasis
BMD – Bipolar Mood Disorder
CHF – Cardiac Heart Failure
CMY – Cardiomyopathy
COP – Chronic Obstructive Pulmonary Disease
CRF – Chronic Renal Disease
CSD – Crohn’s Disease
DBI – Diabetes Insipidus
DM1 – Diabetes Mellitus Type 1
DM2 – Diabetes Mellitus Type 2
DYS – Dysrhythmias
EPL – Epilepsy
GLC – Glaucoma
HAE – Haemophilia
HYL – Hyperlipidaemia
HYP – Hypertension to view Formulary
IBD (UC) – Inflammatory Bowel Disease (Ulcerative Colitis)
IHD (CAD) – Ischaemic Heart Disease (Coronary Artery Disease)
MSS – Multiple Sclerosis
PAR – Parkinson’s disease
RHA – Rheumatoid Arthritis
SCZ – Schizophrenia
SLE – Systemic Lupus Erythematosus
TDH – Hypothyroidism
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Billing Code for Rapid HIV test
PROCEDURE CODE TO BE USED FOR RAPID HIV TEST:
4614 – HIV AB – RAPID TEST (R151.59 as at 08/11/2024)
Medical Aid Scheme: Fraud, Waste and Abuse
Addressing FWA is crucial for ensuring the sustainability and affordability of medical schemes in South Africa
It requires a multi-faceted approach involving all stakeholders in the healthcare ecosystem.
Here’s a summary of Fraud, Waste, and Abuse (FWA) in South Africa’s medical schemes industry.
10 Key Takeaways:
- Financial Impact: FWA is costing the South African medical schemes industry billions of rand annually, leading to inflated healthcare costs and increased financial strain on members.
- Member Consequences: Members face three major repercussions:
- Higher insurance premiums
- Reduced benefits
- Risk of schemes becoming financially unsustainable
- Types of FWA:
- Fraud: Deliberate deception
- Waste: Inefficient use of resources
- Abuse: Excessive or improper use of services
- Administrative Burden: Significant resources are spent on managing and investigating FWA claims, diverting funds that could be used for improving healthcare services.
- Technology Solution: The industry is moving towards using automated systems, AI, and data analytics to detect unusual patterns and potential fraud in real-time.
- Collaborative Approach: Success in combating FWA requires collaboration between:
- Medical schemes
- Healthcare providers
- Regulatory bodies
- Member Education: Schemes need to empower members with information to help identify fraudulent practices and understand their benefits better.
- Enforcement Measures: Strong consequent management is recommended, including:
- Legal action against offenders
- Prison sentences
- Significant fines
- Cross-scheme blacklisting
- Industry Responsibility: Medical schemes and administrators are viewed as custodians of the healthcare system with a duty to protect members’ access to essential services.
- System Sustainability: Without swift action against FWA, the entire medical scheme ecosystem becomes compromised, affecting trust in healthcare funding and quality of care.
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2024-Prevailing-Dispensing-Fee
2024 Prevailing Dispensing Fee:
Medinol Instructions:
- Go into Medinol, Main Menu
- Process
- Command Prompt
- At the Command Prompt, Enter SYSMAINT
- At the matching fields towards the bottom enter Threshold = 158.70, Rate = 30.0, Fixed Value = 47.61
- Press Enter to continue past all further fields on Page 1, Page 2 and Page 3
- At the Command Prompt, Enter EXIT to return to the Medinol Main Menu
- For the new settings to take effect, Escape out of the system to get back to Windows, then re-enter Medinol
ALL THE BEST