Patient Consent & Billing Policy

Our Billing Policy is modelled on the most recent coding structure prescribed by the Medical Doctor’s Coding Manual (MDCM) which is a registered product of SAMA. This manual is the general accepted industry reference. Along with the above-mentioned we also subscribe to the published PPBU Coding Guideline.

Should a dispute of any kind arise with regards to the validity of codes used in the preparation of an account by one of our associates, Kimberley Anaesthesia Association will consider the rules and guidelines as presented in the most recent Private Practice & Coding Guidelines as the correct and most suitable ethical interpretation. The afore – mentioned is a document published by SASA annually.

There is a wide variety of medical schemes available to private patients in South Africa. Since 2004 all individual medical schemes have been creating their own payment structures.

When it comes to anaesthetic accounts, they are prepared based on specific units. Each unit reflects a certain level of expertise that is required for any individual procedure. Any account will, for that reason, contain any number of consultations, anaesthetic time, clinical units and procedural codes. A specific fee is then associated with each individual unit as stated on the account. The Practice Standard Tariff consists of Consultation units, Anaesthetic units, Clinical units and Procedural codes and is calculated based on the Discovery Classic Fee structure as the tariff policy.

Services delivered outside of regular business hours (19:00 – 07:00), including weekends, as well as unscheduled emergency cases during normal business hours, will be charged at a higher rate as a result of the costs incurred to deliver said service. Anaesthetic cost estimates assume average surgical time and average complexity. The final cost inclusive of VAT at 15% may exceed or be lower than the estimated cost.

Each individual associate of Kimberley Anaesthesia Association may be contracted to certain Medical Schemes. Regardless of the afore mentioned, the patient and/or signee of the patient agreement will remain responsible for the payment of the account in its entirety. The Practice Standard Tariff is determined by taking the value of the service, the cost to the practice to deliver the service and local economic factors into account.

Any account may be managed by Kimberley Anaesthesia Association, and in turn may be submitted to a Medical Scheme on behalf of the patient at no extra cost. The afore – mentioned does not transfer the liability of payment onto the Medical Scheme in question or onto Kimberley Anaesthesia Association. The patient and/or guarantor will ultimately be responsible for payment, including any short payments by the Medical Scheme throughout the account administration process.

All accounts are payable strictly before or on sixty (60) days after service delivery. An account older than sixty (60) days will draw interest and will be handed over to a legal professional for debt recovery.

Prescribed Minimum Benefits is a result of current legislation that allows for specific procedures to be recompensed at cost. This results in the funder having to pay the specific amount in full.

NOTE: ABOVE TARRIFS FROM 2022 AND ARE SUBJECT TO CHANGE*

While we will always aspire to provide the Medical Schemes with the necessary motivation for a complete payment, Medical Schemes have their own rules surrounding reimbursement and could, in some cases, even insist that care should be provided by a physician of their choice.

The Standard Tariff is charged to all patients irrespective of age, economic circumstances or funder involved as required by the Consumer Protection Act.

Possible additional modifying codes may include, but is not limited to: