Frequently Asked Questions
We answer your questions! Our advanced medical billing and administration software
and solutions are ideal for your practice.
Q: My practice deals with IODs from time to time. Can these be submitted as well?
A: We do manage IOD claims on behalf of our clients provided there are gazetted tariffs – these are submitted and processed by a separate IOD claims division within the company.
Q: My practice is new and my bank account information is not yet registered with the various schemes. Can you Help?
A: The initial bank account registration process (as well as any bank account changes/updates) can be a tedious and drawn-out affair. We are able to manage that process on your behalf for a once-off fee.
Q: What kind of recovery rates can I expect?
A: At PracMed we pride ourselves on our collection rate which is on average about 96%*. We also have a large customer base that enjoy a 100%* collection rate.
*Based on regular and consistent submissions by the practitioner.
Q: What if I choose to bill at different rates?
A: Thanks to the flexibility of our software, we are able to manage collections and submissions to meet individual billing requirements, be they at scheme rates, PMB rates or at a custom-defined billing structure.
Q: How do you handle the write-offs on my behalf?
A: Although we do direct all our efforts towards minimising your practice bad debt, it is not always possible to eradicate such bad debt and it forms part of any going concern where up-front payment is not guaranteed. Only after we have exhausted all collection avenues do we request that an account be written off. All write-offs are done in accordance with each practitioner’s requirements and consent.
Q: Can I just use your software to bill my claims?
A: Our software platform, Pulse, is not offered as a stand-alone product. It forms the backbone of our submissions process but is part-and-parcel of our comprehensive bureau service we offer. You can however, choose to bill on the software directly as opposed to sending claims to us for capturing whereafter we look after the recovery.
Q: How do you deal with international patients?
A: International and foreign patients can be managed, but the key to successful collection is immediate action. For all foreign patients, the required paperwork needs to be in place (such as a guarantee of payment from the government or insurer). We use exhaustive efforts to manage the collection from foreign patients, but once patients have returned to their home country, the collection probability drops drastically.
Q: How do you reconcile the payments made into my account?
A: Once we receive a payment remittance from a scheme, we use that to reconcile monies paid into your bank account. In order for us to provide that service, we do ask that each provider supplies us with regular bank statements. In instances where we are not provided bank statements, then we supply that provider with copies of the remittances to verify payments made.
Q: What will the service cost me and how is it calculated?
A: During our initial assessment of your practice, we analyse your practice type, size and needs. Ultimately, we want to offer a favourable cost-to-benefit ratio for your individual practice. Unlike some of our other competitors, we charge a fee based on your actual income, not your billing. We submit claims electronically via EDI so there is a switching fee that is charged over and above our service cost (Healthbridge is our switching partner).
Q: I have a dedicated receptionist or practice manager – will I still need them?
A: Absolutely. The frontline of your business is one of the most important facets of your practice and PracMed’s role will be to support that function and not replace it. The day-to-day administrative tasks will still be managed by your receptionist/practice manager at the front-end. We take care of the back-end: from accounts and payments management to reducing bad debt and liaising with the various medical aids – all of these activities and actions are recorded in the form of notes and reports taking the guesswork out of what was actually done and what the current status is of a claim, medical aid account or patient interaction.
Q: I am new to private practice and not completely familiar with the billing and coding process. Will PracMed do my billing?
A: As an administrative entity, PracMed cannot bill on behalf of a medically trained clinician. We are however, able to offer advice and guidance to new practitioners based on sound and proven billing protocols. Any claim form submission would at minimum need to have all the required ICD-10 codes along with the necessary procedure descriptions. Based on that, we can offer guidance on appropriate billing. We will not amend or alter claims in any way once received, unless there is prior consultation with the relevant provider.
Q: How long will it take before I get paid for my claim submissions?
A: Payment frequency is determined by each individual scheme in the form of regular payment runs. Some schemes pay out claims monthly, others weekly and some on their own schedule. With our software, our claims are submitted in real-time, so the claims processing and verification process starts immediately. As a general rule of thumb, the more often claims are submitted, the more often and more consistently they will be paid out. PMB and IOD claims do have differing timeframes for processing and payments and we follow strict guidelines for those claims to minimise delays.
Q: I still want to be involved in my practice without being hands-on daily - how will I know what is going on in my practice if I am not involved 100%?
A: Not only will you be appointed with a dedicated account administrator to refer any queries to, but as part of each month-end, we do provide a broad range of reports detailing what is happening with your practice accounts. Custom or ad-hoc reporting needs can also be catered for, provided that they are discussed and agreed to. Lastly, practice owners and managers can also have high-level access to their database for any other overview needs.
Q: If a medical aid rejects a claim, do I lose the money?
A: Not at all – we manage the full process of submissions, as well as rejections. Any errors in submissions are identified and rectified to ensure accurate claims go through. Should a scheme reject or part-pay a claim that is valid, we follow an escalation process to minimise the patient’s liability. In cases where the patient is indeed liable, then we recover the money from them on terms that are suitable for the provider.
Q: What if the patient does not pay or cannot be located/contacted?
A: We use an exhaustive communication process to make contact with a patient through our highly qualified credit controllers – all conducted in a professional manner. We understand the balance needed between getting results and maintaining the integrity of your practice. As a last resort, we will issue a legal letter of demand to the patient for outstanding accounts.
Q: Will I be required to sign a contract to use PracMed’s services?
A: Yes – we do require each practitioner to sign a contract that defines the relationship and expectations. We make a significant investment into each and every individual practice and we ask that you, as the client, reciprocate the same level of investment in us. The initial term of the contract is 6 months.
Q: How will I manage the data and maintain my database of patients using your software?
A: There is no need for data management at practice level – all data is stored on your behalf on our cloud-based servers. We have failsafes in place to ensure business continuity at all times. This data remains your property, but we take the hassle of data management and the need to do back-ups off your hands. Our system is also live, so any changes or additions made are implemented in real-time and are instantaneous.
Q: Will I have a dedicated account manager to manage my business?
A: Yes – each client will be appointed an account administrator which has extensive knowledge of your billing codes, procedures and other discipline-specific requirements. Also, we work with each new practice in the initial stages to create a unique client profile detailing any specific needs. We do not believe in a one-size-fits-all approach
Q: What will happen to my existing system and data should I choose to move to PracMed?
A: Although we will make all efforts to transfer existing data into the system, we cannot guarantee compatibility of your existing data.
Contact An Expert
Have you still got a few unanswered questions? We’d love to assist you. Kindly get in touch with us and one of our consultants will take care of your concerns.