| How to import / update your medical aid tariffs for 2019: 1. 2019 rates. These rates are supplied free of charge as a courtesy to our users. If you do not understand how the billing works please read this https://madetomeasure.freshdesk.com/solution/articles/17000069875-how-the-billing-works-. The basic procedure is to import the Discovery rates (4 below) and then import the Medical Aid %'s(5 below) If the imports give problems you can update the Tariff Codes and Medical Aids manually - see https://madetomeasure.freshdesk.com/solution/articles/17000075575-how-to-update-your-medical-aid-rates-manually' 2. This Update includes: i/ Discovery rates (DHR) for most of the allied disciplines (see 4 below) for funds that use the DHR. ii/ Medaid %'s for the funds that use the 2010 base rate to calculate the price for each code. NOTE This will not be 100% accurate to what the fund pays. It is an approximate value. To improve accuracy see 6 below. iii/ Namibian rates iv/ IOD rates will only increase in April. v/ Private rates are never provided - maintain them yourself. 3. Backup and update the program: Take a backup. If you are not on the latest version it is advisable do the update. Professional users apply Profupdate from this Knowledge Base ( this is important - if you have a file date earlier than April 2018 and have a VAT % of 15 the program will think you are Namibian and update your medical aids to the Namibian ones instead of the SA ones). Synergy users go to Housekeeping -> Upgrade in the program. 4. Get the new Discovery rates (DHR): i/ Disciplines 91 Biokinetics, 04 Chiropractics, 08 Homeopathy, 66 OT, 72 Physio, 86 Psychology, 82 Speech Therapy / Audiology, 81 counselling, 84 dietetics, 83 Hearing aid Acoustician, 88 Nurses, 89 Social Work, 13 Oral Hygeine, 68 Podiatry, 85 Psychometry, 22 Psychiatry, 39 Radiology, On the tariff code screen go to 'Import' then 'WebUpdate' then again 'Import'. ii/All other disciplines - On the tariff code screen use the 'Increase' button to increase the Discovery column by 5% for the 2019 increase. NB Before billing check each code price to those from the Discovery website - if you charge too much by 5c they will pay the patient instead of you. iii/ If you have a special contract with Discovery you will need to enter the special rates that replace the DHR. iv/ Doctors and specialists can calculate more accurate rates using units and RCF see 7 below. 5. Update the medaid %'s. On the Medical Aid screen, go to 'Import', then 'WebUpdate' , then again 'Import'. On Professional any funds that have been set to use their own column will revert to the Medaid 2010 column after this update and you will need to reset them to use their special column again. This will not happen in Synergy where only those funds that use the MedAid2010 column will have their %'s changed. Physio's will need a special column for the Bestmed rates Note that if you have set patients to use a different rate to the medical aid standard, then they will revert to standard when you do this update. 6. Improve accuracy on funds using % based billing. i/ Tweak the % to suit your practice / discipline - Do this easy calculation for a few of your codes to get a range of %'s Medaid 2010 price is the price for the code on tariff code screen in column2 Actual price is the published actual rate that the medical aid says they will pay for that code. (Actual price - Medaid 2010 price ) / Medaid 2010 price x 100 = % above the 2010 rate that this medical aid will pay for this code Add 100 to this % before entering it in on the Medical Aid screen in the Billing % It is best to use the lowest of the range of %'s you get so that all your invoices are = or slightly less than the published price. This way you will avoid irritating small amounts that have to be written off. ii/ For 100% accuracy you will need to create a column of rates especially for the fund. Use the 'columns' button on the tariff codes screen and type in the actual rate per code. Then go to the Medical Aid screen and change the billing on the fund to use the new column at 100%. Funds that it may be helpful to do this for are GEMS, NMS, Bestmed, Bankmed. Physios will need to set up a special column for Bestmed as they have added new codes and also changed the weightings on existing codes which makes them impossible to calculate from the 2010 base rate. Note that Professional users are limited to 5 extra columns while Synergy users have no limit on columns. iii/ Exception codes can be created for specific codes when the % increase does not work - especially for Doctor's consultations. (See Helpfiles - 'exception' ) 7. Doctors - Improve accuracy by calculating from units and RCF RCF values are available for most funds / plans. 2019 DHR RCF are: GP anaesthetist (AU type 30 ) =85.386 Spec anaesthetist (AU type 30 ) = 102.464 CPU (clinical procedure units type 20) =13.567 To use this option see HelpFiles 'Tariff codes Units' 8. Help with updates. The procedure is explained here https://madetomeasure.freshdesk.com/solution/articles/17000075574-how-to-update-your-medical-aid-rates-from-within-the-program and in the helpfiles Datamax support can help you telephonically with these updates. Note that if you have problems with anti Virus software blocking the downloads you may require the services of a technician. For most disciplines it is also easy to update the rates manually - see https://madetomeasure.freshdesk.com/solution/articles/17000075575-how-to-update-your-medical-aid-rates-manually 8. Disclaimer. While we try our best to give you the most accurate information possible, we cannot be liable for any errors / discrepancies. Please check your rates and adjust as needed. 9. Medical Aid %'s These %'s represent the accumulated increases by each fund over the past 9 years and are used, in conjunction with the MedAid2010 rate, to calculate each treatment line's value.
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2019 Rates and Medical Aid %'s Print
Modified on: Mon, 7 Jan, 2019 at 2:33 PM
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