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BHF will appeal benefits judgment
Believes the judgment is bad news for consumers.
The Board of Healthcare Funders (BHF) will appeal against a court ruling that requires medical aids to pay in full for prescribed minimum benefits’ (PMB) conditions.
“The BHF believes the judgment is bad news for consumers, as the uncertainty with regards to pricing of healthcare will continue,” it said in a statement on Thursday.
On Monday, the High Court in Pretoria ruled that PMBs, which protect members of medical schemes, must remain in place.
The BHF was one of the respondents in the case.
It was hoping the court would give a clear understanding of the implications of regulation eight of the Medical Schemes Act 131 of 1998.
The regulation states that medical schemes must pay for the diagnosis, treatment and care of all PMB conditions in full, or at the price charged by the health care provider.
Therefore, private healthcare providers, could for example, inflate their prices with the knowledge that it exceeded costs that might be incurred by government hospitals, clinics and the like.
The industry body said it would appeal the ruling as the principles and merits of the matter did not appear to have been considered.
“We believe that this judgment may negatively affect the sustainability of medical schemes, which have been under severe financial pressure due to the opportunistic and reckless charging by some healthcare providers for PMB.”
It said it was concerned that medical schemes may have no choice but to raise contribution premiums and this would affect its members.
“Over the past few years, the healthcare provider fraternity has been partly or fully responsible for the scrapping of all healthcare pricing guidelines and undermining the coding structure.”
This had increased costs within the private healthcare sector.
“We believe that the judgment will allow this untenable situation to continue,” said the BHF.
*** FROM MONEYWEB 10 NOV 2011
Protea Medical Aid Society under provisional liquidation
Protea Medical Aid Society under provisional liquidation
Date: 19 April 2011
Press release 2 of 2011: Protea under provisional liquidation
Mr Velaphi Petsana was appointed curator of Protea Medical Aid Society on 29 October 2010 in terms of in order of the Western Cape High Court.
On 5 April 2011, the curatorship was cancelled and the medical scheme was placed under provisional liquidation in the hands of the Master of the Western Cape High Court, following reports from the curator.
The order of 5 April 2011 was published in the Cape Times on 7 April 2011 and Die Burger on 8 April 2011.
Interested persons have until 19 April 2011 to show cause to the court as to why the final order of liquidation should not be granted.
The Master of the Western Cape High Court has appointed Mr Ralph Farrell Lutchman of Concord Administrators (Pty) Ltd and Mr Raphael Brink of Brink & Thomas Attorneys as provisional liquidators of the scheme.
Mr Lutchman’s contact details are as follows:
E-mail: ralph@concordadmin.co.za
Tel: 012 362 6580
Cell: 084 5151 335
Concord Administrators (Pty) Ltd can also be contacted on 0861 874 926 or 012 333 6162.
The contact details of Brink & Thomas Attorneys are as follows:
Tel: 021 424 1564
Fax: 086 666 7799
Section 64(3) of the Medical Schemes Act 131 of 1998 provides that during liquidation the provisions of the Act continue to apply to the medical scheme as if the liquidator were the person managing the business of the medical scheme.
The provisional liquidators advise that:
* they are engaging service providers who have or are providing healthcare services to members of Protea;
* they are attending to the claims of the service providers; and
* all actions against the members of Protea must be kept in abeyance while the liquidation process unfolds.
“At the time when we applied for liquidation, the scheme’s solvency ratio was such that a single large claim could deplete its reserves entirely, leaving members exposed,” said Registrar of Medical Schemes Dr Monwabisi Gantsho today. “Where trustees fail to exercise their fiduciary duties, the regulator is forced to step in and take the necessary measures to protect the members of a struggling scheme.”
The latest audited figures show that, at the end of 2009, Protea had just over 7 000 beneficiaries and a solvency of 19.0%.
Brokers are again advised to act with restraint. Any advice they give must accord with the principles of best advice, have the best interests of their clients at heart, and be based on a proper assessment of the situation.
Medinol Practice Management Software users are advised not to accept Protea Medical Aid members for treatment on medical aid.
MEDINOL MEDICAL BILLING | PRACTICE MANAGEMENT SOFTWARE
Medinol is one of the few purpose-built practice management application to meet the unique needs of independent private healthcare providers.
Today Medinol helps over 130 providers throughout South Africa run more efficient and profitable practices, while delivering outstanding patient care.
As an on-premise software, Medinol and the data it manages, is fully under your control. This enhances your independence and privacy: what happens in your rooms, stays in your rooms.
Medinol helps manage your patient information, generates your billings, submits your claims, controls your outstanding debtors, and get your accounts paid quickly.
Medinol has been in operation since 1984, demonstrating its proven efficacy.
Medinol’s mission is to help independent practices succeed in an ever-changing healthcare environment.
More information can be found at https://medinol.co.za.
Contact:
Fudley Bezuidenhout Pr.Eng.
Founder and CEO
Email: info@medinol.co.za
Ph: 021-906-2296
Cell: 082-688-9610
2015 Tariffs|Rates
2015 Tariffs – Medical and Dental
Don’t you just love this time of the year? NOT!!! The scrumaging around for the new year’s tariffs, the uncertainty, and the effort it takes to review and update tariffs and prices for fees to be used in 2015?
Medical Practitioners (GP’s)
The 2015 Tariffs encompasses consultations, procedures and special rates (insurance companies, etc). As per previous years, we choose the route of lowest common denominator. This is motivated by the overarching need to preserve year-end (slow month) cash flow, by avoiding medical aid rejections at all costs.
By way of example, what we do, in the case of say urine analysis, where different medical aids pay different rates, we choose to deploy the lowest rate/tariff to make sure we get paid by all medical schemes.
Medinol Medical Users:
Contact our offices on 021 906 2296 to get your 2015 Medical Tariffs Update.
Also, if dispensing is your thing, we have an update for these as well. Our Lazy Dispensing GP’s Genie will provide a comprehensive lookup of all medication showing SEP and dispensing (SELLING) price. Click here to get it.
Non-Medinol Medical Practitioners:
For reliable, easy and one of the most effective Medical Billing Software in South Africa, click here.
Dental Practitioners (Dentists)
The 2015 Tariffs encompasses consultations, procedures and laboratory fees. As in previous years, the size of this file is in the region of 880 records. Depending on your respective patient volumes, you can elect to choose either the 2015 Discovery Rates, DENIS Rates or GEMS Rates.
Danger with 2015 Discovery rates: if you are contracted in and you charge one cent more than the published tariffs, payment will be made to the member, not you. If you persist in this behavior (without correcting), your practice will be deemed as non-compliant and yours will be flagged internally by Discovery as being eligible for non-direct payment. This means all payments will be made to the member, not you.
MEDINOL Practice Management Software-ONLY Dental Users:
1. Click here to get your 2015 Discovery-Based Dental Tariffs Update
2. Click here to get your 2015 GEMS/MHG-Based Dental Tariffs Update.
3. Click here to get your 2015 DENIS Dental Tariffs Update.
Otherwise, Non-Medinol Dental Practitioners:
For the best Dental Practice Management Software in South Africa, click here.
Athlone Dental Practice for Sale
Dental Practice for Sale Athlone Cape Town
Date: 14 June 2019
Great practice, great price, great location. Periphery of Athlone CBD.
In operation for 8 years.
Sold as a going concern.
Reason for selling: owner to specialise.
Make a quick offer. This will not be on the market for much longer!
For more info click the link below:
MEDINOL MEDICAL BILLING | PRACTICE MANAGEMENT SOFTWARE
Medinol is one of the few purpose-built practice management application to meet the unique needs of independent private healthcare providers.
Today Medinol helps over 130 providers throughout South Africa run more efficient and profitable practices, while delivering outstanding patient care.
As an on-premise software, Medinol and the data it manages, is fully under your control. This enhances your independence and privacy: what happens in your rooms, stays in your rooms.
Medinol helps manage your patient information, generates your billings, submits your claims, controls your outstanding debtors, and get your accounts paid quickly.
Medinol has been in operation since 1984, demonstrating its proven efficacy.
Medinol’s mission is to help independent practices succeed in an ever-changing healthcare environment.
More information can be found at https://medinol.co.za.
Contact:
Fudley Bezuidenhout Pr.Eng.
Founder and CEO
Email: info@medinol.co.za
Ph: 021-906-2296
Cell: 082-688-9610
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