New guideline health tariffs mean greater certainty

The Health Professions Council of South (HPCSA) this week published “guideline tariffs” for medical practitioners who are obliged to register with the council.

Doctors will be able to charge more than these tariffs but will have to obtain your written consent to do so.

The guideline tariffs may also be used by medical schemes when they set their benefits.

Rajesh Patel, head of benefit and risk at the Board of Healthcare Funders (BHF), the organisation that represents schemes and their administrators, says the BHF will ask the HPCSA to make tariff recommendations for next year that schemes can use.

Two years ago, doctors and other healthcare providers succeeded in getting the North Gauteng High Court to strike down the guideline tariffs then used by medical schemes and medical practitioners, the Reference Price List (RPL).

The HPCSA’s guideline tariffs are based on the RPL published in 2006 and adjusted for inflation.

The 2006 RPL was published by the Council for Medical Schemes. The 2008 and 2009 lists were published by the Department of Health but were struck down when the court found that the department’s process for determining the tariffs was legally flawed.

The HPCSA published the highest tariffs that doctors could charge without obtaining your written consent but it scrapped these tariffs in 2008 in favour of the RPL.

Without guideline tariffs for the past two years, schemes have been setting their own benefit rates. Where schemes have not contracted with doctors to charge members these scheme rates, members have been faced with uncertainty over cover for their medical bills.

Dr Buyiswa Mjamba-Matshoba, chief executive officer of the HPCSA, says the guideline tariffs should clear up the billing confusion in the healthcare industry and are “a fair interim measure that will guide practitioners on billing, protect patients and enable the council to adjudicate on complaints of overcharging”.

Minister of Health Dr Aaron Motsoaledi has announced the government’s intention to set up a regulated negotiating forum to set healthcare tariffs.

His department is in consultation with the Competition Commission on the mechanism that can be used to achieve this goal.

Bertha Peters-Scheepers, senior manager for public relations at the HPCSA, says that when you consult a doctor, you should ask him or her to list for you all the procedures involved and their codes, the guideline price for each of these procedures, and the doctor’s charge for each procedure.

BHF spokesperson Heidi Kruger says the HPCSA’s guideline tariffs will bring welcome certainty for schemes and their members.

She and Patel say there has been a lot of manipulation of the medical codes practitioners use, and the HPCSA’s tariffs should ensure that everyone works off the same list.