Fast, Accurate Solutions for Medical Billing Procedures
Complex Medical Billing Procedures Need Simple, Fast, and Accurate Solutions
In South Africa, doctors, dentists, physiotherapists, audiologists, and other healthcare professionals who elect to provide their services independently, rely, for the bulk of their income, on payments from the country’s registered medical aids on behalf of their members. Once registered with the Health Professions Council, and in possession of a valid practice code number, private practitioners are entitled to submit claims to any of the more than 80 medical aid funds currently operating, for payment of the amount due for services to a fund member, in accordance with the terms and conditions of his or her membership. For this purpose, there are a number of possible medical billing solutions.
On occasions, a patient might may be required to pay a service provider directly, and to submit a claim for retrospective reimbursement by his or her medical aid fund later. For this purpose, the member might have the option to do so by email, by post, or over the counter at the insurer’s offices. Even for a relatively minor claim, the medical aid member is required to supply quite a lot if detail, and much of this needs to be obtained from the service provider.
Most often, it will be the healthcare practitioner who is responsible for the submission of claims. Each fund may have slightly different requirements, further complicating the medical billing process, and fuelling the need for a simpler solution than collating and submitting all of the necessary data manually.
A typical claim must provide the personal details of the main member, as well as those of the dependent member where he or she was the one treated. In addition to the name of the scheme and the relevant membership number, the practice code, in the case of a group practice, the names, and registration numbers of each individual service provider involved in the treatment must be given. Finally, the diagnostic code number and those relating to each service rendered, the nature and cost of each of those services, and the date on which they were provided, complete the minimum legal requirement. Clearly, the claims process alone makes reliance on manual medical billing solutions a highly impractical option for a busy private practice.
A late or incorrectly completed claim can lead to delays in payment or even to rejected claims. Medical aid payments are not the only source of practice income that can often pose problems for its owners. In many cases, the cost of a professional service provided to members of a medical aid is covered in full by the fund. There are, however, occasions on which, under the terms of membership, the patient may be responsible for covering a portion of the costs, and so, medical billing solutions must also include a mechanism for collection of these co-payments.
Whoever may be responsible for managing the financial affairs of the practice needs to be made aware that a co-payment is required, bill the patient accordingly, and then check that the payment has actually been received. Already a time-consuming process, it can become even more so when a patient fails to make the required payment on time, triggering the need to generate reminders, should these fail to produce a response, perhaps even to initiate legal action. It is believed that the failure of in-house medical billing solutions to handle the recovery process effectively is costing private healthcare practitioners in South Africa millions of Rands every year.
So, what is the answer? How can the shortfalls inherent in traditional systems be overcome? As has been the case with many other time-consuming and exacting tasks, the answer is to be found in the use of computers and specialised software programmes. In this case, any effective, proprietary medical billing solution must address the complex accounting needs of a private healthcare practice, comply with South African legal requirements and those of the nation’s various medical aid funds, as well as make provision for the update of these requirements should they need to be revised.
For a practice to purchase and utilise such systems could simply mean swapping an accounting problem for the alternative and equally burdensome responsibility of maintaining it, and may even require employing an IT specialist.
Not only does V Professional Services offer one of the most comprehensive computerised medical billing solutions designed specifically to comply with South African requirements, but access to its many functions is offered as an online service, requiring no up-front investment or responsibility for maintenance.