Schemes Administered by Universal Health
Universal Medical Schemes
Heads up! For more information about any of our medical schemes, please follow the links to:
Practice Management
Practice Management
BONITAS TIME-BASED CUSTOM TARIFF CODES
BONITAS TIME-BASED CUSTOM TARIFF CODES
Date: 16 Oct 2018
Healthcare Professionals (GP and Specialist) are invited to participate in the Medscheme Bonitas time-based
reimbursement model pilot starting 1 November 2013. Healthcare Professionals currently using the 0190, 0191
and 0192 range of tariff codes are invited to participate by submitting 4 new customized tariff codes (Psychiatrists,
Anesthetist and Maxillofacial surgeons are excluded). Those healthcare professionals who choose not to participate
can continue to use the current codes and will still be reimbursed as per the current status. The intended duration
of the pilot will be 6 months but this will ultimately depend on the uptake.
The 4 new customized time based tariff codes are indicated below:
TARIFF CODES TABLE
TARIFF
CODES
DESCRIPTION
07326
New or established patient: Office or outpatient visit requiring up to 10 minutes. This
would typically involve problems of minimal severity
07327
New or established patient: Office or outpatient visit requiring from 10 to 20 minutes.
This would typically involve a problem focused history, clinical examination and straight
forward decision making for a minor problem
07328
New or established patient: Office or outpatient visit requiring from 20 to 40 minutes.
This would typically involve a detailed history, clinical examination and straight forward
decision making or counseling.
07329
New or established patient: Office or outpatient visit requiring over 40 minutes. This
would typically involve a comprehensive history, clinical examination and complex
decision making or counseling for a complex problem
OPTION CODE TABLE
SCHEME/ PLAN/OPTION NAME OPTION CODE
BONITAS HL DD PROCEDURE & CONSULT BODPC 664823
If you have any questions, please call the Bonitas Contact Centre on 0861 112 666.
MEDINOL MEDICAL BILLING | PRACTICE MANAGEMENT SOFTWARE
Medinol is one of the few purpose-built medical billing software engineered 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.
Established in 1984, Medinol has pedigree, demonstrating robustness and proven efficacy.
Medinol’s mission is to help independent practices thrive in an ever-changing South African healthcare landscape.
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
Announcement: SwitchComm Plus 1.19
All MediSwitch clients please take note:
There is a pending update for SwitchComm Plus V1.19, about which you should already have received and email.
The update will execute automatically if your practice has been auto-flagged.
If, however, you elect to manually perform the upgrade yourself, here’s the link to the uploaded image:
MediSwitch support: 0800–111–703
Medshield Medical Scheme under provisional curatorship
From the Council for Medical Schemes:
Press release 17 of 2012: Medshield Medical Scheme under provisional curatorship
The North Gauteng High Court in Pretoria placed Medshield Medical Scheme under provisional curatorship today, following
the successful application of the Council for Medical Schemes to address governance concerns at the scheme.
Council is the regulator of the medical schemes industry, responsible for enforcing compliance with the Medical Schemes
Act 131 of 1998 to ensure that the interests of beneficiaries are prioritised at all times.
The provisional curator, Mr. Themba Langa, replaces the current Board of Trustees and Principal Officer and must ensure
that a new Board takes over the reigns at Medshield in due course, one that is fit and proper to run the affairs of the
scheme.
Assurance to beneficiaries
Beneficiaries of Medshield should rest assured that the claims-paying ability of their scheme is not affected by the
provisional curatorship.
Dr Monwabisi Gantsho, Registrar of Medical Schemes and Chief Executive of the Council said: “The provisional curatorship
has nothing to do with the financial soundness of the scheme. There are no concerns whatsoever over the financial position
of the scheme.”
Medshield remains one of the largest and healthiest schemes in the market. At the end of 2011, the scheme had over
236 000 beneficiaries and a solvency of 36.6% – which is above the 25.0% required by the Medical Schemes Act.
Medshield remains financially sound and sustainable in the long run. Dr Gantsho added: “I am looking forward to a speedy
return of the scheme to sound governance. The curator will be working very closely with the Regulator in this regard.”
Advice to brokers
Brokers are advised to act with restraint. Any advice they give must accord with the principles
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Bonitas claims price war victory over Life Healthcare
Bonitas, South Africa’s third largest medical scheme, is claiming victory in what it believes is the beginning of a competition and price war with private hospitals, notes Rapport.
The newspaper reported that Bonitas announced the exclusion of 14 large Life Healthcarehospitals for its 750,000 insured lives and warned they may do the same with other major groups.
Bonitas spends R360m annually at the 14 Life hospitals, and has imposed a 30% co-payment for members who continue to use these hospitals. Life Healthcare head of financers’ relations, Matthew Prior, says the group has waived the 30% so that Life patients who are members of Bonitas may continue to use their facilities without a financial burden.
The report says that according to acting chief officer Gerhard van Emmenis, this effectively means a 30% discount for Bonitas and a much better deal for the scheme. ‘I think every medical scheme is now standing at Life’s door asking why they cannot also get a 30% discount.’
He says the gap between the tariffs negotiated by the two largest schemes – Discoveryand GEMS – and what smaller schemes pay hospitals is getting wider. Bonitas plans to target the National Hospital Network (NHN) – a group of independent private hospitals – next.
NHN has an exemption from the Competition Commission to bargain as a collective with medical schemes, but Bonitas is planning to challenge this practice in court.