NHRPLNational Health Reference Price List
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There are many other billing practices inherent in the NHRPL that would not withstand logical scrutiny.
One of the first prominent actions of SAPPF was to issue a legal challenge to the Department of Health to challenge the NHRPL, which proved successful.
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.
Terblanche said that for the HPCSA to replace the ethical tariff (three times the NHRPL) with the NHRPL when the benchmark Reference Price List (RPL) had yet to be finalised (verification of the cost studies still underway) 'simply boggles the mind'.
The HPCSA is in the process of evaluating its tariff processes and how the NHRPL process will impact on this in the future and to determine if there will be value in harmonising the processes in the interests of health care consumers.
SAMA said 'In order to engage the DoH on the NHRPL and related matters, SAMA secured a meeting with the Director-General of Health to discuss the sustainability of private practice health care service delivery for 2008 and beyond.
When the Council for Medical Schemes (CMS) was faced with incorporating practice cost studies (which SAMA spent millions on expertly compiling) it merely passed the NHRPL onto the national health department.
47), and the NHRPL tariff increase was 5.2% for 2005.
The codes and rules include the International Classification of Diseases, Version 10 (ICD-10), the National Health Reference Price List (NHRPL), and individual medical scheme rules, as detailed below.
Each line represented a claim for a procedure (laboratory test) as defined in the National Health Reference Price List (NHRPL) as published by the Board of Healthcare Funders and subsequently the Council for Medical Schemes.
The temptation to increase the number of tests per event will also be removed by removing the episode fee component from each individual National Health Reference Price List (NHRPL) item and substituting it with a single new NHRPL code for an episode fee.
These relate to the hospital rating system, refusal to pay for certain drugs and the setting of tariffs below NHRPL for certain medical disciplines and for certain codes.