What determines Physiotherapy rates & price
If you are a registered service provider of a medical aid, certain conditions to the agreement may apply. Each medical aid is different. Every medical aid sets their own reimbursement rate for each code that physiotherapist use.
Treatment codes are universal, but price per code vary. To see a comparison between the top 5 biggest medical aids and how much they are willing to pay, see our article here.
Medical Aid Scheme Rate
This is the amount that the medical aid and SASP has established to be fair compensation for a particular assessment or treatment technique. The base rate is 100% of the scheme rate. Some patient’s option of medical aid determines if the medical aid covers 200%, or 300% of the scheme’s base rate.
Freedom to choose your own rate. Think carefully before you setup your own price without understanding the full weight of the decision. Each option has its benefits and drawbacks. Merely choosing the same rate as the physio down the road, may just be the worst decision you can make.
The time, duration & date of service must be recorded. Especially when treating hospital patients which is seen twice a day.
The treatment location or address must reflect on each invoice. Multi-location practices share patients between locations.
Every patient must be diagnosed, therefore each diagnosis corresponds to a diagnostic code. Every diagnosis in existence is captured and allocated a certain code called an “ICD-10 code”. Some patient require more that one diagnostic codes depending on their problem. Multiple sites each may need with different diagnostic code.
For obvious privacy reasons the diagnosis description must not reflect on the invoice, only the diagnostic ICD-10 Code.
Treatment codes are treatment or procedure codes that physiotherapist must use so the medical aid understand that you’ve done to their member. Codes can be used in combination or alone, but there are specific rules when which of these codes may be used.
For more details and guidelines how to use treatment codes, please see our article that handles about the topic.
Modifiers are codes that adjust the value of the code amount. Some modifiers are required according to billing rules. See our article on billing codes to understand how and when you use these modifier codes.
Medical aids require all of these requirements in a set format in which this information of each treatment session must be set out. A page that merely contains the total paid by the patient, is inadequate. Medical aids will reject the invoice or statement and not reimburse your patient. SARS also requires these details in order to be a valid invoice to be used as a Tax deductible. This is a necessity why the format of of your invoices are correct.
Medical aids demand that all of the above, must be in-line with each other to avoid confusion at the medical aid
If you take all of the above info consideration you will understand that there are many factors you must be aware of when submitting a physiotherapy claim to a medical aid.
Don’t even attempt a DIY project when it comes to medical aid claims. Rather team up with a billing company that understands all the aspects of the physiotherapy industry to help you reach your practice’s potential.
Once all the info are captured the claim is submitted to the medical aid. Either Electronically or manually.