PMB cost im­pli­ca­tions ‘will be huge’

Weekend Argus (Saturday Edition) - - GOODWINES -

The po­ten­tial cost im­pli­ca­tions of the le­gal in­ter­pre­ta­tion of a Med­i­cal Schemes Act reg­u­la­tion that deals with the pay­ment of PMBs is huge, the Board of Health­care Fun­ders (BHF) says in a state­ment re­leased with the court ap­pli­ca­tion this week.

The BHF says if health­care providers in­crease their charges for PMBs be­cause they know schemes will have to pay what­ever they charge, you, as a mem­ber of a scheme, could face an av­er­age con­tri­bu­tion in­crease of 18 per­cent.

The BHF says a re­cent study by an ad­min­is­tra­tor an­a­lysed doc­tors’ claims from Jan­uary 2009 to July 2010 and found that if all doc­tors be­gan charg­ing at 300 per­cent of the now struck-down Ref­er­ence Price List (RPL) tar­iffs, schemes’ claims would in­crease by 20.4 per­cent. This would trans­late into an 18-per­cent con­tri­bu­tion in­crease, on av­er­age.

A fur­ther study, the BHF says, found that among doc­tors sub­mit­ting PMB claims to a scheme that re­im­burses at 100 per­cent of the for­mer RPL, only three per­cent charged more than the scheme’s rate.

How­ever, the claims of a scheme that re­im­burses up to 300 per­cent of RPL showed that 48 per­cent of all prac­tices charged this scheme more for in-hos­pi­tal ben­e­fits than they charged the scheme that re­im­burses at 100 per­cent of RPL, the BHF says.

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