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®MediKredit BasiKIN THIS ISSUE:

Some of our top practices

of 2007

Office Zen

FIND US

Win a prizeto the value of

R250

One on one with Dr RJ Heger in Gauteng

Maintainingyour weight

in the classifieds

Describe the profile of your practice.

About 80% are medical aid patients. 20% are cash patients. We claim directly from the medical aid on the patient’s behalf. We have a mixed patient spectrum with possibly larger than usual elderly patient base.

Why did you choose MediKredit?

I needed a more effective way of electronic claiming.

Our debtors list reflected a deteriorating cash flow. I was interested in something that involved less staff time in terms of follow up on rejected claims.

How long have you been using MediKredit?

Since mid 2006, but only late in 2006 to Jan 2007 we began utilizing the full benefit of MediKredit.

Describe the set-up within the practice in terms of the process flow from the moment the patient comes through the door.

Patient file is drawn before patient arrives.

An Eligibility Check is done by the receptionist. Any problems found here are sorted out before the patient has the consultation.

In the consultation the visit/consult is captured by the doctor and the claim is submitted real time through ADSL to MediKredit.

If there is a problem with a claim (feedback within 8 seconds), the patient is given the file and asked to see the account ladies.

Any claim short falls i.e. owed by the patient are settled before the patient leaves the reception.

Dr RJ Heger in Gauteng

Do you consider MediKredit as a valuable addition to the management of your practice?

If so, what is the added value that Medikredit offers you?

Yes, the age analysis has improved. Everything over 60 days has gone from 24% to 9% (this includes 90 days, 120 days and 150+ days).

It has also encouraged me to be more hands on with our practice management software, and more familiar with the details of account management.

Describe your experience of MediKredit’s service levels.

Support has been excellent. Staff have been willing to go beyond the call of duty to sort out any problems and help in the training of my staff; most staff members had to learn the process from scratch and two were totally computer illiterate.

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Any co-payment

owed by the

patient is settled

before leaving

the practice.

Patient Confidentiality

1. What is personal health information (PHI)?

PHI is information about an identifiable, natural person and

includes information about a patient's physical or mental

health, well-being or disability. Codes such as ICD-10 codes

and NAPPI codes are also forms of PHI.

2. What responsibilities do health care providers and their

staff have when it comes to the use of PHI?

Providers and their staff must maintain the privacy, confiden-

tiality, security and integrity of PHI at all times. They must also

set up control measures to prevent unauthorised access to

PHI.

It is to be noted that patient confidentiality and information

security are legal obligations. Health care providers should

conclude written confidentiality and non-disclosure agree-

ments with their third party service providers to ensure that

PHI is protected at all times.

3. When may personal health information (PHI) be dis-

closed?

When the patient or legally authorised person has consented

thereto in writing. To obtain proper informed consent, the

health care provider must explain to the patient who is going

to see the information and what the information will be used

for.

The provider must also explain the likely consequences of

non-disclosure of the PHI as set out below. Where necessary,

a patient must also be made aware that PHI will be shared

within the health care team to ensure continuity of care

unless the patient objects. Health care providers should

consider displaying conspicuous notices in their waiting

rooms regarding the use of PHI such as ICD-10 codes on

accounts.

4. What will happen if a doctor or other health care provider

does not put an ICD-10 code on a patient's account?

The medical scheme will reject the claim and this can result in

non-payment of the claim. Refusal to provide PHI to a

medical scheme makes it difficult for it to conduct clinical and

financial risk management.

5. What will happen if codes for non-disclosure of clinical

information (for example U 98.0 or U 98.1) are used on

accounts?

The medical scheme will have the discretion to either pay the

claim from day-to-day benefits or from the member's savings

account or to reject the claim depending on the rules of the

medical scheme in question.

Winning is BasiK

Here is your chance to WIN a prize to the value of

R250! All you have to do is answer the following

question:

What will happen if a doctor does not submit an ICD-10 code

on a patient's account?Answer:

Enter your answer, cut out the entry form and give it to your MediKredit Representative.

May you be the lucky one!!!

Telephone #:

Name:

MediKredit Helpdesk: 0860 932 273Helpdesk Hours:Member Queries: 24hours/dayOther Queries: Monday-Friday: 08H00-18H30

Saturday: 08H00-13H00Fax: 011-770 6195Email: enquiries@medikredit.co.zaWebsite: www.medikredit.co.za

BUSINESS + TECHNICAL SUPPORT

EASTERN CAPE:Business and Technical Support: Clement Kiewiets 082 558 6411

GAUTENG NORTH EAST/MPUMALANGA/NORTHERN PROVINCEBusiness and Technical Support: Clint Patel 082 821 2298Technical Support: Noelan Soobramoney 083 324 8345

GAUTENG SOUTH WEST/NORTH WESTBusiness Support: Robert Jubber 082 306 5919Technical Support: Noelan Soobramoney 083 324 8345

KWA-ZULU NATAL:Business Support: Janine Tully 083 262 9696Technical Support: Avikesh Premchand 083 309 6372 WESTERN CAPE/NORTHERN CAPEBusiness Support: Vanessa Fernandez 082 339 7800Technical Support: Mark Bezuidenhout 084 471 8462Cape Town Office: 021 4426620

Find us in the Classifieds

Area:

Issue 1 of 2007

Smart data ... Healthy decisions.

Why use real-time claiming?

Did you know?

PatientConfidentiality

Why use Real-Time Claiming?

Single Exit Price Increase

Pharmaceutical Manufacturers will charge

pharmacists and dispensing doctors 5.2%

more for medicines. This is the first

increase in the single exit price in three

years. This increase is based on inflation

and the rand-dollar exchange rate.

Dispensing doctors licenses

All dispensing doctors need to renew their

dispensing license for 2007. In 2004 it was

made a requirement by the Department of

Health for a dispensing doctor to acquire a

dispensing license. This license was valid

for three years. Providing medicines to

patients without such a license is a criminal

offence.

NHRPL 2007

The NHRPL for 2006 may be used for

2007, with a minimum 4.9% increase

adjustment to the tariff. This is due to the

fact that the NHRPL for 2007 has not yet

been published.

PCNS payments clarified

Resultant from a number of members

questioning the payment of Practice Code

Numbering System (PCNS) fees to the

Board of Healthcare Funders (BHF), the

following clarification is given:

PCNS and the Medical Schemes Act:

The introduction of the PCNS system is

encapsulated in the regulations to the

Medical Schemes Act 131 of 1998 (GNR

1262 October 20, 1999). In terms of

Regulation 5, accounts by suppliers of

services must contain amongst others the

following:

"(e) the practice code number, group

practice number and individual provider

number issued by the registering authori-

ties for providers, if applicable, of the

supplier of service and, in the case of a

group practice, the name of the practitio-

ner who provided the service."

Some of our top practices

Schedule 0 medicines

From 16 March 2007 until 19 November

2007 all registered Schedule 0 medicines

are excluded from the operation of the

Pricing System provisions (sec 22G) as

well as the Bonusing provisions (sec 18A)

as prescribed by the Medicines and

Related Substances Act, 1965.

This means that for this period manufac-

turers, wholesalers and distributors have

no restriction on the price that they could

charge for schedule 0 medicines and that

volume discounts can also be applied in

respect of Schedule 0 medicines.

Claims not meeting the standard are rejected immediately which enables us to make the necessary changes straight away and resulting in NO delays in payment from medical schemes.

MediKredit’s immediate response enables us to recover any short payment due by the patient, while still at the practice.

Western Cape - Dr Mellett & Partners Kwa-Zulu Natal - Dr GK Brink Practice

Left is Elsa Scholtz (Accounts Dept)Right is Miana Liebenberg (Practice Manager)

Janine Sacco and Claire de Jongh (Practice Staff), Dr GK Brink, Janine Tully and Avikesh Premchand (MediKredit)

Did you know?

Office Zen

Maintaining your weightYou have been dieting, exercising and generally suffering-but you have made it! You finally lost that 5 kilos you've been dragging with you since the December holidays. The main issue now is to keep the weight off permanently. To be able to do this you need to incorporate healthy behaviors in to your routine so that they become a natural part of your lifestyle. How do you do that?

Here are a few ideas to keep you committed to permanent weight loss.

1. Eat three healthy meals a day. Do not skip a meal as this just increases hunger and leads to excessive snacking or over eating at the next meal.

2. Never skip breakfast. It is the most important meal of your day. When you wake up in the morning your blood sugar is low, so you need to eat. A good way to start your day is to have a high-fiber breakfast cereal e.g. bran flakes, shredded wheat or oatmeal sweetened with fruit rather than sugar.

3. Fruits and vegetables. Have sliced bananas or strawberries with your morning cereal. Stir berries in your yogurt. Enjoy a vegetable sandwich with tomato, lettuce, onion, peppers and cucumber.

4. Exercise 30 minutes each day. Our bodies are designed to be active. Moderate exercise decreases your appetite and increases your metabolic rate. It has been found that people who don't exercise eat more than people who do a little exercise.

5. Weigh yourself regularly. Weigh yourself weekly and keep record of your weight. This way you can tell whether your efforts are working.

6. Plan your meals for the whole week. Make a detailed grocery list and stick to the list when you are doing your shopping. Never shop when you are hungry and avoid on-the-spur shopping.

7. Don't keep comfort foods in the house. Remove all edible temptations; especially if you tend to snack, or eat high-fat, high-calorie foods when you're upset or depressed or bored. Stock up your house with whole grain products, nuts, fruit, vegetables and low fat snacks

8. Food portions. Take slightly less than what you think you'll eat.

9. Create opportunities to be active. Climb the stairs in stead of using the lift. Wash your car at home instead of going to the car wash. Walk to the shops. Play with the kids.

Chuckles

With acknowledgement to Randy Glasbergen

10. Sit down for a meal. Avoid eating in front of the television or reading while you are eating. Concentrate on your food during meals and enjoy every mouth full.

11. De-stress your day. Stress may cause you to eat more. Spend at least 20 minutes every day doing what you enjoy most. Have a warm bath with bubble bath, candles and soft relaxing music. Watch your favorite TV program, read a book, listen to your favorite music. Exercise, deep breathing, muscle relaxation techniques and even a good laugh can ease stress.

12. Eating out. When it comes to eating out you need to be choosy. Watch out for the hidden sugars and fats in sauces and dips. Avoid fried food; rather go for grilled or boiled. We tend to eat more food in restaurants than at home. Share a dish, or decide what and how much you're going to eat before you start and have the rest as a take away.

13. Plan healthy snacks. The best snacks include fruits, vegetables, whole grains and low-fat dairy products. Examples of healthy snacks are brown rice cakes with low fat cottage cheese, fruit smoothies, sliced fresh fruit and yogurt, carrot and cucumber sticks with hummus or a slice of rye bread with peanut butter...

14. Look for a distraction when you're fighting a craving. Tidy your cupboards, go for a walk, call someone or work in your garden. The cravings will quickly disappear when your mind is occupied with something else. Sugar cravings take about 7 days to disappear. After that your food cravings will virtually vanish.

15. Reward yourself. Losing weight and maintaining your weight is a major accomplishment. Celebrate your success with non-fattening events e.g. new shoes, clothes, a facial or a special outing.

Resources:www.mayoclinic.co.za

“The Holford Low-GL diet” - Patrick Holford

The Medical Schemes Act and its regula-

tions are however, silent on the payment of

a fee to obtain a practice number.

Official SAMA viewpoint:

“There is currently no specific enabling

legislation authorising any entity to levy a

fee in order for doctors to obtain a practice

number to ensure payment of accounts by

medical schemes.”

Background to PCNS:

The administration of PCNS was originally

done by the Council for Medical Schemes

who put out an open tender. This tender

was allocated to the BHF. The services

rendered by BHF require an infrastructure

to be maintained and as such, costs are

involved. The costs incurred by BHF are

borne on a 50/50 basis by the funding

industry and the service providers.

In view of the above, and in view of the fact

that although a doctor may elect to run a

cash practice, to enable his/her patients to

claim back from their medical schemes, it

is advised that members pay their PCNS

fees.

SAMA also serves on an advisory commit-

tee of the PCNS and has requested that a

meeting of the committee be held to

discuss the finalisation of the legal

structure in which the PCNS should

function.

For further information in this regard,

please contact Monwabisi Gantsho of

SAMA's Private Practice Unit on:

012 481 2027 or

email monwabisig@samedical.org