2015 Dispensing Fee change for Doctors
2015 Dispensing Fee change for Doctors
Practice Management
Practice Management
Primecure Dental Laboratory Claims
RE: DENTAL LABORATORY FEES: REMINDER NOTIFICATION REGARDING THE BILLING PROCEDURE REQUIRED FOR DENTAL LABORATORY FEES FOR ALL SCHEMES AND OPTIONS ADMINISTERED BY PRIME CURE
Dear Dental Service Provider:
Please note that in order to comply with industry standards and SADA’s Professional Billing Guidelines, Prime Cure has changed their system with immediate effect regarding the payment of dental laboratory procedures for all schemes and options administered by Prime Cure. The following please need to be adhered to in order to ensure the payment of dental laboratory procedures.
1. Electronic submission:
Please note that the payment of laboratory fees claimed by any practice on behalf of a dental laboratory will only be processed for payment in the event that all laboratory procedure codes and fees feature on the electronically submitted invoice by the dentist in accordance with the SADA Billing Guideline (and not only code 8099), excerpt as follows:
Electronic submission of invoices directly to a patient or medical aid fund
The total fee charged by a dental technician for laboratory services shall be indicated on the dentist’s invoice by submitting code 8099 – Dental laboratory service with the appropriate laboratory fee on the line following the relevant dental procedure code on the date on which the dental procedure was rendered.
The technician’s invoice shall be certified by the dentist (or a person appointed by the dentist) for correctness by means of a signature. The original invoice of the dental technician shall be filed by the dentist for record purposes.
The laboratory fee shall be submitted electronically for payment on the date on which the procedure code is submitted for payment, and the appropriate dental laboratory service codes and fees shall be reported on the lines following code 8099.
2. Manual submission (“paper claims”) of invoices for direct submission to a patient or medical aid fund.
In the event of manual submission of accounts the original laboratory account (or a copy thereof) must accompany the invoice of the dentist to ensure payment for laboratory procedures as per SADA Billing Guideline excerpt below:
o The total fee charged by a dental technician for laboratory services shall be indicated on the dentist’s invoice by reporting code 8099 – Dental laboratory service with the appropriate laboratory fee on the line following the relevant dental procedure code.
o The technician’s invoice shall be certified by the dentist (or a person appointed by the dentist) for correctness by means of a signature.
o The original invoice of the dental technician (or a copy thereof) shall accompany the invoice of the dentist and a copy (or the original) shall be filed by the dentist for record purposes.
We thank you for your kind co-operation herein and should you have any queries please do not hesitate to contact our call centre at 0861 665 665
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HPCSA Being Investigated
The HPCSA is formally being investigated over several allegations relating to maladministration and improper eHealth procurement procedures.
On March 10th Health Minister Aaron Motsoaledi announced that the Health Professions Council of SA (HPCSA) is formally being investigatedover several allegations relating to maladministration and improper eHealth procurement procedures.
Head of Department of Medicine at the University of Cape Town and chairperson of the National Health Research Committee, Professor Bongani Mayosi, will lead the investigations with a team of medical, law, information technology and administration experts.
Time to Leave Windows XP Behind
Support for Windows XP officially ended last April
That’s it. It’s finished. Done. No more. Don’t expect to see any future patches, services packs, fixes, hotfixes, critical updates, anything — if you’re one of the remaining admittedly large percentage of users holding out till the end, you’re already at the mercy of the elements in the Wild Wild West of computing.
So, what does that actually mean? Simple: You have to upgrade. There are no buts about it; staying on Windows XP is a bit like seeing a waterfall ahead on a river and opting to stay in the boat instead of safely paddling to shore.
You might not know when you’re going to go over the precipice, but it’s likely that something quite bad is going to happen to you at some point in your future.
We’re not just being overdramatic for the sake of it. Why do you think a number of businesses are spending a small fortune to get their systems upgraded as quickly as they can?
Why do you think that a number of them are likely going to be paying Microsoft a princely sum for XP support after the fact, as they’ve simply been unable to upgrade important devices like, say, ATMs before the big cutoff date?
If you’re still not convinced — or know those that need a little bit of extra convincing — please realise that yes, it’s now time to kick this legacy OS to the curb for good.
GEMS Bemoans Inappropriate ICD-10 Z-Code Usage
Dear Doctor
THE INAPPROPRIATE USE OF Z-CODES IN CLAIMS SUBMITTED TO THE SCHEME
It is almost a year since GEMS’ communication to healthcare practitioners encouraging the use of specific ICD-10 Codes on claims submitted to the Scheme.
The recent GEMS audit done on claims received to date indicates the continued use of Z-Codes on a number of claims that have been processed by the Scheme.
The high utilisation of Z-Codes by some healthcare practitioners was discussed at great length at the meeting held between GEMS and the South African Medical Association (SAMA) in 2015. SAMA reinforced their position in discouraging the use of Z-codes in instances where the healthcare practitioner is aware of the diagnosis. It was mutually agreed that, going forward, the inappropriate use of Z-Codes would be closely monitored, discouraged and kept to an absolute minimum. It was further agreed that comprehensive ICD-10 Codes must be included on all referrals and scripts.
The value of using accurate ICD-10 coding classification for diagnosis codes
Providing the appropriate ICD-10 Code is especially important for claims that qualify as prescribed minimum benefits (PMBs) and for patients who need to access their chronic benefits. In these two instances the inappropriate use of Z-Codes may result in; the depletion of your patients’ savings, claims being short paid, rejected or paid from an incorrect benefit.
Our partnership with SAMA and GEMS to promote coding accuracy
We encourage all healthcare practitioners to submit a valid ICD-10 Code that accurately relates to the condition that the patient has been diagnosed with.
The inappropriate use of Z-Codes also has a significant impact on our ability to effectively;
- Structure comprehensive benefit packages
- Process claims correctly
- Monitor resource utilisation
- Track public concerns and assess risks of adverse health events
- Measure the quality, safety and efficacy of care
For more information on ICD-10 Codes, please visit the Department of Health website at www.health.gov.za (PATH: Documents/Notices).
To view or validate an ICD-10 Code, visit the GEMS website at www.gems.gov.za(click on Healthcare Providers and then ICD-10 Code/Formulary Check).
Kind regards
GEMS Network Management
PG Bison Medical Scheme Amalgamation
Dear Trading Partner and Practice Manager
PG Bison Medical Scheme will be amalgamating with Discovery Health Medical Scheme from 1 May 2014
We want to let you know that the members of PG Bison Medical Scheme will move to the Discovery Health Medical Scheme (DHMS) from 1 May 2014. The destination remains the same as current.
Claim submission information
Claims with a service date from 1 May 2014
Please start sending claims to Discovery Health using these members’ new Discovery Health Medical Scheme membership numbers. They will receive their membership cards during the first or second week of May 2014.
Claims with a service date before 1 May 2014
Please finalise all reversals of claims with a service date up to 30 April 2013 for PG Bison Medical Scheme.
Claims with a service date before 1 May 2014 must still be submitted to the Administrator (ALLCARE) for processing.
PG Bison Medical Scheme will not accept any claims with service dates from 1 May 2014.
Please note that the information contained in this communication on the proposed amalgamation of PG Bison Medical Scheme and Discovery Health Medical Scheme is subject to the Council for Medical Schemes’ approval of the transaction.