NHRPLNational Health Reference Price List
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A practitioner should charge a non-insured patient the NHRPL rate, except where the patient provided written informed consent for a billing higher than this rate.
A practitioner could also charge a private-paying insured patient a rate payable by the patient's medical scheme if the rate was higher than the NHRPL rate.
For the purposes of establishing whether the patient had provided informed consent, the practitioner 'must tell the patient the prevailing NHRPL or medical scheme rate for whatever procedure the patient presents for,' said Mkhize.
To aggravate matters there was no tariff increase that year and, until 2008, only 'below inflation' annual increases, making the proposed NHRPL tariff ridiculously low, especially for specialists requiring high overheads to retain professional standards.
According to SAMA 'The current NHRPL does not take into consideration the realities of actual practice costs, as well as the deemed equivalent state packages for medical professionals.
Studies conducted by independent health care consultancy HealthMan indicate that the current NHRPL tariffs will have to increase by at least 170% for procedures and by 120% for specialist consulting codes to reflect the cost of running a private practice.
Using a 'complex' process in which service providers arrived at prices based on the NHRPL and costs of the service with a salary component thrown in before dividing this figure by the number of minutes in a year, they had arrived at a rand-per-minute rate.
The details are still to be worked out and there's no clear relationship between the bargaining chamber and the NHRPL in the bill.
A total of 643 NHRPL procedure codes are potentially available for billing pathology procedures.
As liver function tests (LFTs) are not identifiable with a unique NHRPL code, gamma glutamyl transferase (GGT) is used as a surrogate marker of LFT.
Urea and electrolytes is a profile identifiable by a single NHRPL code and is one of the few instances where the cost of the profile is less than the sum of the components.
The Premier Rate for Specialists involves specialists charging Discovery members higher fees (125% and 150% of the NHRPL list for in-hospital codes and out-of-hospital codes respectively) in return for identical payouts and a single rate across all plan types (excluding KeyCare).