In short a practice Billing policy is your practice’s policy to bill medical aid tariff, above or below scheme rate.
Deciding your practice billing policy is one of the most important decisions, it will have a direct affect on your practice income. The billing policy must be decided by the directors in advance. Once the billing policy is in place it has to be applied consistently. For example if the practice billing policy is to charge scheme rates, you have to charge all patients at their medical aid rate. Normally the billing policy will consist of two parts. Medical aid patients and private patients. Your billing policy might also be determined whether you have a cash only practice, or accept cash and medical aid as payment.
All patients will be issued with a detailed invoice and statement regardless if you have a cash only practice or medical aid/ cash practice. The patient must still be able to claim back from their medical aid if they want to or use it for tax purposes.
Benefits of charging scheme rates is medical aids pay the practice directly. So it helps with a steady cash flow. It also assures full payment of claims if the patient still has benefits available. If you charge above scheme rate there will always be short payments that need to be settled by patients. It’s also a selling point for a practice if they offer the service to claim on behalf of a patient, as most patients find it inconvenient and time consuming to claim back themselves. A lot of patients choose their providers based on if they are charging scheme rates or not.
Although there is no clear law on how much a physiotherapist may charge, there is a guideline and prices must be fair.
Inconsistent billing practices might raise a red flag at the medical aid. You don’t want to be audited by any medical aid. They can backdate incorrect payments made to the practice going back years and hold the practice liable. Physio billing advice and assist you with your billing practices according to the correct guidelines to prevent this from happening.