RPL Statement 2009

On 4 February 2008 the Director General of Health invited interested parties to make submissions on a Reference Price List. Upon the request of provider groups, the Director General of Health extended the final date for submissions to 19 May 2008.

Of the 48 submissions received, 37 submissions did not comply with Regulation 3 (2) of the Regulations relating to the obtainment of information and the processes of determination and publication of a reference price list. These 37 submissions were not satisfactory for one or more of the following reasons:

It was therefore not possible to make a determination about a reference price list from the information presented in these submissions. All 48 submissions have been increased by 8.7% of the 2008 reference price list schedule.

During this comment period provider groups have been invited to submit additional information that make assist in the determination of a reference price list.

The remaining 11 submissions complied with the information requirements as outlined in Regulation 3 (2) and are currently being verified. The 11 submissions to be verified are the following:

The comments for the 37 draft schedules should be made in writing and sent electronically to Mr. Siyabonga Jikwana at jikwas@health.gov.za by no later than 12 o'clock on the 10th October 2008.

http://www.doh.gov.za/docs/nhrpl-f.html

Minimum Salary

According to a resolution taken by the South African Dental Technicians Council, the minimum salary for technician employees has increased with 15% (fifteen) to R7,590.00 per month.

Please contact the DENTASA Employee Representive if you would like to bring any employee matters to our attention.  Claudia Greselin 011-789 6383.

Look for the Four ways to get your money under Members Only.

Why Practice numbers and ICD-10 Codes?

Who, when and why.

All healthcare providers who service medical scheme members are required to obtain a practice number from BHF. This number must be quoted on every claim submitted by the provider to the medical scheme. In the absence of such a number the claim can not be processed by the scheme.

It should be noted that, under the conditions stipulated by the Council for Medical Schemes for the administration of the PCN system, it is required that all the users of the system are required to contribute towards the running and maintenance of the system through the payment of annual registration renewal fees. Of the 45 000 healthcare practitioners registered on the system, to date, BHF has no record of payment by 7 237 of these healthcare practitioners. We are forced, therefore, to de-activate these practice numbers as from the 6th August 2007.

BHF is the custodian of the the Practice Code Number System (PCNS), which is an index of healthcare service providers registered on a database. Its purpose is to identify registered healthcare professionals and facilities duly authorised by the relevant statues. The system enables healthcare practitioners to practise legally and is critical for reimbursement of claims, when services are rendered to medical scheme members. BHF scrutinises the references and qualifications of all applicants before registering them on the system and ensures compliance with applicable legislation.

The system enables healthcare service providers and medical schemes to determine the legitimacy of any professional, identify his/her status and area of practice. It thus also serves as a tool to minimise fraud and abuse by illegitimate practitioners.

The practice number, allocated to all registered healthcare providers is the essential billing code that triggers the process of reimbursement of a claim to either a medical scheme member or service provider. This is in accordance with the requirement of the Medical Schemes Act 131 of 1998 wherein it is stated that a medical scheme may only reimburse a member or a provider of relevant healthcare services for services rendered against a valid practice code number.

ICD-10 Coding Standards

In terms of regulation 5(f) of the Medical Schemes Act (Act 131 of 1998), it is a requirement that all registered providers of healthcare services include diagnostic codes on accounts or statements that may be used to claim benefits from medical schemes and administrators.

Tel: 012-460 1155     Fax: 012-460 9481   Mon-Fri 08:00-13:00

The Dental Technology Association of South Africa

dentasa@absamail.co.za