CURRENT
The NHRPL 2010 (National Health Reference Price List (RPL) - 2010) has been published by the National Department of Health.The National Health Reference Price List is intended to serve as a baseline against which medical schemes can individually determine benefit levels and health service providers can individually determine fees charged to patients. Medical schemes may, for example, determine in their rules that their benefit in respect of a particular health service is equivalent to a specified percentage of the national health reference price list. It is especially intended to serve as a basis for negotiation between individual funders and individual health care providers with a view to facilitating agreements which will minimise balance billing against members of medical schemes. Should individual medical schemes wish to determine benefit structures, and individual providers determine fee structures, on some other basis without reference to this list, they may do so as well.
Practitioners are allowed to charge patients at the rate at which medical schemes are prepared to reimburse their claims. However, charges by practitioners above the rate at which medical schemes are prepared to reimburse their claims must be done with the patient's informed consent. Any charge up to and possibly exceeding the Council's ethical tariff must be negotiated and agreed upon with the patient.
Important ruling on ethical Tariffs
The Health Professions Council of South Africa (HPCSA) has taken a decision to scrap its ethical tariffs used by doctors as a ceiling for patient accounts in future. This decision will come into effect once the Department of Health has finalized its extensive consultative process with stakeholders in determining a new National Health Reference Price List (NHRPL).
As a regulatory body aiming at protecting the public consumers of healthcare services, the HPCSA will, however, still retain its authority to determine whether a practitioner has overcharged a patient or not, in terms of Section 53 of the Health Professions Act 1974.In order to make this determination, the HPCSA has adopted the following principles:
· a practitioner shall charge a non-insuredpatient the NHRPL rate except where the patient provides written informed consent for a billing higher than the NHRPL rate and any charge above the NHRPL rate without the patient’s consent shall be deemed to be overcharging;
· a practitioner may charge a private-paying insuredpatient a rate payable by the Medical Scheme to which that patient belongs or is a member if it is higher than the NHRPL rate provided that any rate higher than the rate payable by the Medical Scheme shall be deemed to be overcharging, except where the patient has given written informed consent for a charge higher than the Medical Scheme rate; and
· for the purposes of determining whether the patient has provided informed consent, the practitioner is required to indicate to the patientthe prevailing NHRPL or Medical Scheme rate for whatever procedure the patient presents for as well as the difference between that rate and the rate the practitioner intends to charge as well as the amount that the patient may have to pay in addition to the stipulated rate.
In calculating the prices in this schedule, the following rounding method is used: Values R10 and below rounded to the nearest cent, R10+ rounded to the nearest 10cent. Modifier values are rounded to the nearest cent. When new item prices are calculated, e.g. when applying a modifier, the same rounding scheme should be followed. Vat exclusive prices appear in brackets.
ENQUIRIES
· What fees can I charge as a practitioner?
· What can I expect to be charged as a patient?
Cliff Nkuna
Email:
Tel: 012 338 9367
OR
Qiniso Mthembu
Email:
Tel: 012 338 9367