Javascript is disabled in your browser.
Click here for the solution.
Skip Navigation Links. 		 

Billing Policies

The National Health Reference Pricelist (NHRPL) has not been published since 2009.  Since then each medical scheme has published it's own pricelist each year, resulting in an administration nightmare for medical service providers.  Fortunately Panacea solves this problem by providing all available pricelists via it's Tariff Wizard .  The wizard first examines your database to determine what needs to be updated, then provides you with options.  Once you have selected from the available options Panacea automatically implements the pricelists as well as your billing policy.

To assist you in deciding on a billing policy two scenarios will now be presented with guidelines on how to implement them.  Please remember that the policy that suites your practice may be a combination of the two, or may even be something completely different.  Only YOU can decide what is best for your practice.  Also, please check ethical and legal issues with your own representative organization as Bytemark will not dispense this type of advice.

Scenario 1: Scheme Matching

This scenario involves charging the same amount that a patient's medical aid will pay.  Panacea handles this very well since it can maintain an unlimited number of Pricelists and these can be set as a default per funder.

Drawbacks of this approach:

  • you will actually be charging different amounts for different patients which may seem unfair
  • complexity
  • some medical aid tariffs are quite low

Advantages of this approach:

  • the full fee is covered by the medical aid - no co-payments by patients

To implement this scenario make sure the following items are checked (ticked) in the Tariff Wizard :

  • Re-generate price periods affected by updated tariff tables (if displayed)
  • Generate pricelists and pricelist periods for new tariff tables (if displayed)
  • Link generated pricelists to their funders

Scenario 2: Balance Billing

This scenario involves charging according to a single Pricelist for all medical aid patients.  You would decide what to charge, but for illustration purposes let's say you decide to create a Pricelist called My Medical Aid Rate that is calculated by adding 55% to the 2010 NHRPL.  This rate is slightly higher than what most medical aids will pay, so you will expect your patients to pay in the difference.

Drawbacks of this approach:

  • represents quite a big change in mindset for the practice and it's patients
  • considered by some to be unethical

Advantages of this approach:

  • overall you are being paid more, which may be more in line with what you consider to be fair compensation
  • may be the fairest to all parties involved

Steps to implement Balance Billing:

  1. Make sure these items are checked (ticked) in the Tariff Wizard : 
    • Re-generate price periods affected by updated tariff tables (if displayed)
    • Generate pricelists and pricelist periods for new tariff tables (if displayed)
    • Add Split Billing configurations for generated Pricelists
    • Link Split Billing configurations to funders
    This will add all the necessary Pricelists and Split Billing configurations, then link them to the relevant medical schemes.
  2. Go to Tables - Codes - Pricelists and add My Medical Aid Rate.  On the Automated Updates tab set the Name to NHRPL and Multiply By to 1.55 (for 55%).
  3. After saving the Pricelist, click on Run automated price update, select the appropriate NHRPL Base Rate and click Run Update.
  4. To configure My Medical Aid Rate as your default pricelist click on System - Practice Settings - Practice Setup.  On the Pricelists tab select My Medical Aid Rate under Medical Aid Tariffs & modifiers.

Note: if you decide to implement balance billing please consider your current patients.  If you suddenly change your charge rate you may cause unhappiness.  It may be better to phase in balance billing by implementing it only on new accounts.  The Tariff Wizard  configures each funder to default to balance billing which may be undesirable.  Step 4 also sets your default pricelist.  It may be better to configure each account individually - the Pricelist and Split Billing can be set on the Settings tab of each account.

Conclusion

Regardless of what approach you choose, please check your work thoroughly to ensure that Panacea is implementing your chosen policy correctly.  Bytemark will always be available to help, and we are always interested in your feedback.

Good luck!

To run the Tariff Wizard  now click here .
     
Your Panacea version: Unknown