South African Medical
Association (SAMA) is no longer allowed to publish a
recommended tariff (previously the SAMA Rand value) in its
annual Guide to Billing (GTB) for medical services. The reason
for this is that the Competition Commission decided that SAMA
was contravening the Competition Act of 1998, which prohibits
the setting of purchase or selling prices among those in a
competitive relationship.
Subsequently the Competition Commission instructed the
Department of Health and the Council for Medical Schemes (CMS)
to compile a National Reference Price List for Health Services
(NRPL - HS). It was agreed that this list would be based on
the items, descriptors and units of the SAMA GTB, to which a
Rand value would be added.
The GTB will include the SAMA codes, descriptions and the
units, but not an amount. With this information doctors will
be able to work out a rand conversion factor to determine an
appropriate fee for private patients, which can be higher,
lower or equal to the National Reference Price List.
This means that doctors would be allowed to charge whatever
professional fee they can justify. Patients will be billed for
the difference between the medical scheme benefit and the
professional fee that doctors would generally charge for their
services.
Medical schemes will determine the level of benefits they are
prepared to pay for services rendered. This amount could be
equal to, higher or lower than the National Reference Price
List.
It was agreed that the CMS would distribute the National
Reference Price List to medical schemes and administrators.
This list will not be published but would only be available in
a PDF or read-only format.
SAMA will continue to publish its 2004 GTB, which will include
the National Reference Price List and the injury-on-duty (COIDA)
VAT-inclusive amounts. The Compensation Commissioner will not
publish its structure in a Government Gazette as before, and
will only make this information available on its website.
In light of the above, SAMA's GTB would be the only printed
publication for doctors. The BHF may not publish a Recommended
Scale of Benefits.
| An entry in the 2004 GTB*
would look as follows: |
| Code |
Descriptor |
SAMA Units |
NRPL amounts |
COIDA amounts |
| xxxx |
xxxxxxxxxx |
10.00 |
R50.00 |
R80.00 |
| * Please note that this is
only an example and not based on actual information. |
| SAMA is the only distributor of the
GTB incorporating the NRPL-HS |
| Member price |
R257.00 (subsidized price) |
| Non members |
R771.00 |
| Institutions and Prisons |
R550.00 |
| All other buyers |
R771.00 |
- No discounted price is available for 2nd and subsequent
copies.
- An order form for member and non-members is available on
the SAMA website on www.samedical.org
- Order forms will be posted to all service providers in
private practice (member and non-members), as well as
anyone else that had bought a GTB from SAMA previously.
ENQUIRIES:
- Order forms and posting, contact sama membership
department, tel 012 481 2011
- for additional information on the guide to billing and
the electronic version, contact the sama coding Department
on tel 012 481 2073
|
