Best Practice Guidelines: Healthcare Practice Management & POPIA Compliance Framework

Best Practice Guidelines: Healthcare Practice Management

POPIA Compliance Framework




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10. Billing: Roles & Purpose

10.4. Billing Business Processes

Confirm Contracts with Medical Aid

  • Each Speciality can negotiate with the different medical aids to sign a specific contract with special prices on the Tariff codes. When a contract is signed only that tariffs are allowed to be charged by the practice for their patients. This is not the same as just registering at the Medical aids.
  • Ensure that all contracts signed with the medical aids, by the medical practice, are loaded in GoodX.
  • This ensures that the maximum amounts can be claimed from the medical aids, therefore, optimising the medical practice turnover.


    Billing Screens in the Desktop App and Web App

    The billing screen will be used to indicate the consultation, procedures and any medication or materials that were done or used on the patient, and will be added to the patient account when posted. Some key points that may differ in different apps:

    Invoice Screen (Web App)

    • Generic Medication with prices are available when the medical aid only pays for Generic medication OR when the medication comes out of the patient’s savings, generic medication can be used
    • Integration with MIMS
    • Multiple appointments - this feature can be used to link multiple appointments to one booking. For example, if a parent brings their child in for a consultation and they also consult the practitioner about a specific condition that they may have, then the practitioner needs to create an invoice for them as well as a separate one for the child.

    Periodontal Chart (Web App)

    • The Periodontal Chart is a graphical tool/function for organising all the important information about the Patient's teeth and gums (Plaque, Bleeding, Furcation Lesion, Pocket depths, Mobility, Calculus, Recession) when the Doctor does the Billing after or during the Appointment.
    • Voice command is available for the billing in the Periodontal screen.
    • Treatment plans can be created to assist the practitioner
    • Different pictures for each procedure will indicate on the tooth graphics 

    Multi-Invoice capturing

    • New episode screen will allow the user to invoice the same patient but for different service dates.
    • Repeat code and repeat treatment will allow the user to take one code or all the codes and repeat them over multiple service dates.
    • Invoice analysis will display how the account will post as medical aid or patient liable before the invoice gets posted and indicate the price with the mark-up/ SEP rules that will be applied on the patient stock items.
    • This screen does not allow you to choose the period in which you want to work. Depending on if the practice is on a month-end system or a non-month end system, the invoice will post in the correct period.
      • Month End: The multi-invoice capturing screen will first check the service date, if the period of the service date is open, the transaction will post in that period. If the Service date, if the period is closed the invoice will post in the first open period, so make 100% sure the month-end is done.
      • NON-Month-End (All periods are open): The multi-invoice screen will select the same period as the chosen service date.

    Simple Dental Invoice Screen (Desktop App)

    • All Dentists, Oral Hygienist, Orthodontist and some other specialities will use the Dental Invoice screen. The dental screen will allow the user to see and use the dental chart for the patient.
    • There is also an extra field to specify the applicable tooth numbers.


      Confirm File Details
      • Confirm the Main Member and Dependant details is correct
      • Validations are important to ensure the correct details has been captured and the Patient is an active member on the Medical Aid
      • Make sure all information are up to date.


      Load ICD10s / Codes / Modifiers / Assistants 

      • Load the correct ICD10 codes by using our advanced ICD10 search screen or add multiple codes.
      • Load the correct procedure or consultation codes.
      • Make sure the right modifiers are loaded.
      • Please ensure that your assistant doctor is preloaded in GoodX and linked to a creditor and expense account.


      Estimates

      • An Estimate is a quotation that is created for a patient to give them an indication of how much a treatment or procedure will cost.
      • The quotation or estimate can be used to get authorisation from the medical aid or for private patients to have an idea of how much they will have to pay for the treatment or procedure.
      • The estimate will be saved for when the patient accepts the quotation. The quotation can be used to bill the patient, remove any lines or add some more lines. 
      • A quotation can be emailed or printed.
      • The practice must decide on how long a quotation is valid for. 


      Combinations / Macros / Protocols

      • Combinations are used as a tool to capture commonly used procedures. Before the combination can be used, it needs to be set up in your system. It will reduce the time you spend on billing, reduce errors and prevents you forgetting any procedure codes
      • A combination is also known as a Macro, Basket or Protocol.
      • This is a set of stock, procedures and/or consultations that are always used for a specific treatment.
      • The combination is set up for a treatment with the necessary items and procedure codes.
      • There are 2 types of combinations:
        • Fixed combination: A Fix combination does not have variances in the combination and all the procedures or stock will always be used, with the same quantity. For example a Flu injection.
        • Choose combination: A list of possible items, procedure codes and quantity can be created and when those combinations are chosen the correct items on that list can be chosen before the combination is put on the billing screen. For example a sutures procedure. There can be 3 different sizes of sutures and the correct ones that were used can be chosen, with all the other standard items.

      Send/EDI Claims

      • GoodX provides Practice Management Software and Switching which is integrated directly into GoodX Software. This means you can manage everything from GoodX Software.
      • GoodX Switch allows you to submit claims directly and in real-time into all major Medical Aid Computer Systems and to receive proof of submission and delivery of claims directly into GoodX.
      • Send claim is used for the GoodX Switch to deliver the invoice to the medical aid for payment.
      • The invoice is sent to the medical aid in an electronic format with all the necessary information about the claim.
      • Most of the big Medical Aids can accept electronic claims, but there is still Medical aids that do not accept electronic claims, then the claim must be sent through with a paper claim.
      • The response must be checked immediately. 


      Account Enquiries

      • The full billing and payment history of a debtor and his/or dependants can be seen on the account enquiry screen.
      • The account enquiry screen shows all outstanding amounts payable by the medical aid or debtor.
      • All debtor queries can be responded to from the account enquiry screen.
      • Statements draw their information from the account enquiry screen.


        Add an Assistant (Specialists)

        • An Assistant is another treating Practitioner who assists the practitioner in treating the patient and must be paid for his time and services. 
        • The patient will have a code on the invoice to indicate that an assistant was used and that codes must also be paid.


        Add an Assistant as Creditor (Specialists)

        • The assistant can be added in GoodX as a Creditor.
        • The system will automatically create an invoice for the assistant in the creditor as soon as the medical aid/patient pays the practice and the receipt is done on the patient account.
        • This process will allow the practice to ensure the correct amount is paid over to the assistant at the end of the month.


        Episode Management

        The GoodX Episode Management option is available in the MedDebs Module. The function allows the business to do the following:

        1. The bureau can issue and book a series of numbered billing templates/template books for a medical practice, which will be logged on the system.
        2. As soon as the template books have been completed with billing codes by the medical practice and handed back to the bureau, the template book will be marked as received by the bureau.
        3. As soon as the received template book's billing is captured on the system, the template status will change to "Invoiced", which indicates that the billing instruction has been received and billed.
        The result of this process is that the bureau has a full report of:
        1. the status of all templates issued to medical practices, warning the bureau of issued templates that are outstanding; and
        2. all instructions received by the bureau and if all have indeed been captured on the system.