“I suffer from Information overload…”
Missing the Qualicare emails could cost you a fortune!!!
At CPC/Qualicare we know how overloaded the vast majority of you still are, coping with numerous matters which are not of your own making!
HOWEVER, NOT READING YOUR EMAILS FROM QUALICARE IS A HUGE MISTAKE AND HAS RECENTLY COST CERTAIN MEMBERS DEARLY AS THEY HAVE MISSED ESSENTIAL ADVICE ON:
- PPE BILLING AND CHARGING. Which medical aids have offered to refund, from when, to when etc,
- Episode fees for treating Covid patients, on a mini CAPITATION basis for a period of 14 Days,
- REFRESHING NEW MEDICAL AID CONTRACTS FOR 2021, DISALLOWING DIRECT SPECIALIST VISITS AND VISITS TO EMUs,
- NOTICES OF SPECIAL OFFERS ON PRACTICE SOFTWARE FOR CPC MEMBERS,
- EARLY NOTICES OF MEDICAL SCHEMES WHICH ARE UNDER ADMINISTRATION AND
- FOR WHICH YOU MAY DECIDE TO CHARGE YOUR PATIENT CASH UP FRONT,
- PRACTICES FOR SALE,
- PRACTICE EQUIPMENT TO BUY AND SELL,
- LOCUMS FOR HIRE.
It is hard enough just keeping your doors open day to day, remaining cheerful, avoiding burnout, and keeping your bank manager from calling in your overdraft without:
COVID-19 and all of its ramifications:
- The day to day battle to make ends meet.
- TERS doesn’t work,
- PPE has been refunded in a cavalier manner,
- The changing landscape of updated lockdown rules and amended regulations on how to assess, handle, quarantine and if necessary, isolate your patients, yourself and your staff.
The accelerated and increasing posturing and bullying by the funders, their most recent tactic being to email you directly with:
- Their new updated and often restrictive interpretation of CMS PMB guidelines,
- Explanations of the criteria for becoming a DSP, which frequently have nothing in common with another scheme seeking similar DSPs,
- Demanding adherence to criteria required to get a good Peer profile report, for patients on their schemes ,which are often incongruent with other schemes requirements for a good profile report of your same practice, leaving you angry , confused and annoyed,
- Instructions on how to claim in their particular way so as to fit in with their software (too bad about yours!) and how many claim lines you must use, at your own cost, to receive payment,
- How to navigate through their non-uniform and competing electronic platforms
- Interpreting their myriad of legalese rules which patients expect you to know and obey,
- Understanding their differing “baskets “of care, which do not resemble the baskets of care from another scheme
- Warnings not to balance billing their patients for fear of them unconstitutionally refunding the patient instead of the provider (See the Sechaba judgement further inside this edition of Qualicare news page 46)
the annoying list goes on and on……...
RSA still has over 70 medical schemes, each with approx. 5 sub-options, thus you and your PMS have to be up to date with 350 differing sets of rules, and their resultant decision-making trees! Each scheme behaves as if they are the only scheme in the marketplace and demands intricate and exacting performance from you when assessing, treating, charging and billing your patient. Recently they have introduced telemedicine consultations , pharmacy led nurse interventions with doctor backups, vouchers for prepaid medical services and even incentive prepayments to coax doctors into accepting fees from last century, yet they take NO responsibility for the medicolegal fallout which frequently results from their chaotic system of Managed Care, South African Style.
And so…… you decide that just won’t read your emails from them. Or from anyone else!
You divert them to your receptionist who , often , with the best of good intention , either deletes them due to work pressure, or prints them for you and pops them into your “in” basket where they lay for weeks awaiting your attention for when you have a quiet (?) moment!
In the meanwhile, some of us still sign contracts with the funders, without checking with your IPA if we have read them and picked up hidden warning signs. You don’t read them through, except for the fees section, which often offers you fees from the 1980’s merely in return for giving driving feet through the door into your practice whilst you do not fully know what it costs you, per patient ,to keep your doors open and employ your staff!!
NOT READING YOUR EMAILS FROM QUALICARE IS HOWEVER A HUGE MISTAKE. Missing the Qualicare emails could cost you a fortune!!!
If you delete everything else, PLEASE regularly read your Qualicare emails and your monthly newsletter.
Tony Behrman and the QC Team