Dental Practice For Sale – Woodstock
Established Dental Practice For Sale. Price massively REDUCED for a quick sale. Click Dental Practice For Sale
Practice Management
Practice Management
2017 Polmed GP Tariffs
Dear Doctor
2017 Polmed GP TARIFFS
It is that time of the year again when the annual review of benefits and contributions are finalised for 2017.
The process of the review of benefits and contributions has been completed, in line with guidelines set by the Council for Medical Schemes. A comprehensive review of benefits was done taking into consideration the claims experience, member experience and the financial performance of the Scheme.
The Scheme is pleased to advise that the GP tariff will increase by 6% for both Network and non-Network doctors for consultation codes, namely 0190, 0191 and 0192, which is R376.00 and R348.00 respectively.
All other GP procedure codes will increase by 6% for both Network and non-Network doctors.
Our benefits are grouped into the following categories:
1. Preventative Care benefit
2. Out-of-hospital benefit
3. In-hospital benefit
4. Chronic medication
I would like to thank all the doctors for their contribution and support during this year of 2016.
Wishing you a happy Christmas and a prosperous 2017.
Yours faithfully
Dr Jaco Makkink
POLMED: Medical Advisor and Acting Chief Operations Officer
*********************************************
How to Submit Claims to Polmed
Submit your claims correctly:
Claims must be submitted within 120 days of the service date. Claims received after this period will be rejected as stale. Copies of accounts will be accepted for processing or payment.
There are various ways of submitting claims to POLMED for processing:
Email: polmedcurrentclaims@medscheme.co.za
Fax: 011 758 7660
Post: POLMED, Private Bag X16, Arcadia 0007
20 Claims Medical Aids will not pay for!
Understanding Medical Scheme Coverage: What You Need to Know
It’s a rare and fortunate patient whose medical scheme covers nearly all healthcare expenses. If you find yourself in this situation, consider yourself lucky!
What Medical Schemes Typically Exclude
While many benefits are included, there are certain expenses that most medical schemes are unlikely to cover. Legally, they are not obligated to pay for everything, and to maintain financial stability, most schemes must set limits on their coverage. Although some exclusions may seem obvious, many individuals have attempted to claim these costs.
The Prescribed Minimum Benefits (PMBs)
All medical schemes are required to cover 26 chronic conditions known as Prescribed Minimum Benefits (PMBs). However, beyond these mandated conditions, many other treatments and services are left to the discretion of the individual scheme.
Important Considerations
Keep in mind that schemes often have sub-limits. For instance, while they may agree to cover substance abuse rehabilitation, the benefits may not be unlimited. Additionally, each scheme operates under different regulations, so it’s crucial to familiarize yourself with the specifics of your plan. Take the time to read the fine print—investing just half an hour can save you from unexpected surprises later on!
Don’t be caught unawares by the medical aid’s possible refusal to foot the bill for the following things:
- Injuries sustained in professional and speed contests where medical assistance is available.
- Treatment for obesity – both medical and surgical
- Any costs incurred with regard to infertility treatment or contraceptive devices
- Operations, treatments or procedures for cosmetic purposes
- Any treatment at a service provider not registered with the Medical and Dental Council, the SA Nursing Council or the Homeopathic and Associated Health Professions
- After hours consultation fees, unless it is an emergency
- Sunglasses
- Experimental treatment or procedures
- Unregistered medication (without NAPPI code)
- A telephone consultation with your GP
- Costs of appointment cancelled by members
- Examinations needed for insurance, visa or employment purposes
- The costs incurred if you donate an organ
- Hypnotherapy (some schemes will pay if it is done by a psychiatrist)
- Levies charged by service providers
- Procedures in hospitals if the fund’s case managers deem it unnecessary
- Treatment needed that is related to any breach of the law
- Treatment related to a self-inflicted injury or disease
- Travelling expenses for medical purposes, unless in an ambulance
- Holidays for recuperative purposes
Important Assumptions About Medical Aid Coverage
It’s essential not to assume that your medical aid will cover every expense beyond the basics.However, if you find yourself in a medical emergency—like waking up in the middle of the night with acute appendicitis or breaking your leg after a fall at work—you can rest assured that you will have coverage for these critical situations.
Bonitas placed under curatorship
Bonitas, the country’s second-largest open medical scheme, has been placed under curatorship, ending a two year battle between the scheme and the Council for Medical Schemes (CMS), the regulator said on Wednesday.
The High Court in Johannesburg appointed Joseph Maluleke as the curator on 27 May, and ordered that the scheme have a new board of trustees in place within three months to restore proper governance structures at the scheme, the regulator said in a statement.
Maluleke, who was Bonitas’ compliance officer for the past nine months, was described as someone who had a proven track record of stabilising organisations experiencing governance problems.
“This is a victory for the regulator but more importantly, for the hundreds of thousands of Bonitas beneficiaries and their families,” said CMS Registrar and Chief Executive Monwabisi Gantsho.
“We can all rest assured that the problems which had been plaguing the medical scheme are being addressed in a concrete way. After many months of interaction and litigation we are delighted that this protracted case has finally made satisfactory progress and we look forward to the outcome of the curatorship,” he said.
Bonitas has more than 650 000 members.
The regulator first raised concerns over the fitness and propriety of Bonitas’ board of trustees at the beginning of last year. This followed a probe that began in 2009.
Allegations of corporate transgressions were levelled against the former principal officer, Bafana Nkosi, who resigned before facing a disciplinary hearing.
The same accusations were also borne by members of the board of trustees.
These ranged from investments in property development, for which the scheme paid about R20-million more than planned, to exclusive contracts with suppliers that were governed only by verbal agreements.
The regulator emphasised that placing the scheme under curatorship was not an indication of financial instability or a reflection on its ability to honour claims.
“Bonitas remains one of the biggest and healthiest medical schemes in South Africa.”
The court ruling did not only effectively remove the trustees but also restricted them from ever again taking office as trustees or principal officers.
At the end of 2009, Bonitas’ solvency stood at 35.7 percent, which had remained stable at above the 25 percent required by law.
CMS said the audited figures for the year ending in December 2010 would be published later in the year.
Getting the most out of your practice management software
Doctors everywhere are looking to upgrade IT in their practices. This improves the efficiency of their admin staff by allow more activities to be automated this reducing manual labour. Technology is a big part of becoming efficient and moving towards a smoother running practice.
The health care industry already knows firsthand about technology. Technology has greatly improved how patients are diagnosed and treated. Adoption of technology has been used to develop life-saving treatments.
Therefore, doctors and dentists already know how invaluable IT is. Recently, many have begun to use more and more of IT in the management of their practices. Increased adoption is in the realm of practice management software.
Practice management software has a rich list of useful features. Through active use these features lead to better insight into the happenings at the practice, increased speed and certainly increased effectiveness. Pro-actively using practice management software offers superior decision-making and highly efficient results.
Besides just the billing of claims to medical aids and patients, practice management software has many beneficial features for practices. We all know how very time-consuming claim submission can be for a practice, we indeed recommend that this be the area to focus on first. In today’s warp-speed world, you are virtually compelled to submit accounts electronically via EDI.
Electronic claims must be data-perfect! They must have the proper diagnosis or ICD10 codes, and tariff or procedure codes. Improper codes and incomplete claims will be summarily rejected. Use your practice management software to ensure that the data are correct at the time of billing, and review your claims prior to submission.
If claims contain errors, fix them prior to submission. This is an efficient use of time so work is not doubled up on. And don’t forget to close the loop by tracking all paid and unpaid claims by medical aids and patient.
Credit control is a particularly difficult and unpleasant activity in most practices. Your staff dread having to call medical aids and patients in order collect on unpaid accounts. This is, however, a vital function: your practice loses money each day the medical claims remain unpaid. Utilizing the features of your Medinol practice management software can go a long way towards managing the debt and providing information to help your practice collect.
Fedhealth Validation change: March 2017
1. VALIDATION CHANGE
Please note that with immediate effect, the following validations will apply on claims submitted on the Fedhealth option
indicated in the option code table below.
Exact match checking against the cardholder file will be done on the following membership details:
a) Membership number
b) Date of Birth
c) Dependant Code
d) Patient First Name
2. FAMCHECK FUNCTIONALITY
The FamCheck functionality will be available on the indicated option.
OPTION CODE TABLE
SCHEME/OPTION NAME OPTION CODES
FEDHEALTH HL DD PROCEDURE & CONSULT FHDPC 664874