How do therapists bill?

Minna Antrim said: ‘Experience is a good teacher, but she sends in terrific bills’. If clients are however able to understand what they are billed for, these experiences will be more pleasant.

Some pointers to clarify billing:

  • Each private practice has to be registered at the Board of Healthcare Funders (BHF). Upon registration a unique number is allocated to the practice. It is a legal requirement that this number has to appear on all the invoices as it serves as an identifier that medical aids can use to make sure that the services rendered and codes used are correct.
  • Another important number that you will find on your invoice in the therapist’s Health Professional Council of South Africa (HPCSA) number. This number is another unique number allocated to every registered health practitioner. The HPCSA protects client rights.
  • Therapy tariffs are not set by any regulator. Therapists are responsible to compile a costing of their practice (with assistance of an accountant) in order to determine the amount they need to charge for each 15min time unit. Medical aids do however have a certain amount per therapy code that they are willing to cover and this differs from one medical aid to the next. The amounts covered by medical aids also depend on the plan that the client chooses. This leads to clients have to cover the difference from their own pockets.
  • Different disciplines have their own set of treatment codes. These codes not only serve as an identifier of the therapy the client is receiving, but it also indicates the amount of time the therapist spends with the client. In some cases it could also indicate whether it was a treatment session, an assessment, a school or home visit or even if any assistive devices were made etc.
  • Another code that you will notice on your invoice is the ICD10 code. This is a diagnostic code. Not all therapists are in the position to diagnose conditions that are stipulated in the Diagnostic and Statistical Manual of Mental Disorders and they will thus use codes that are more general, unless the client has a formal diagnosis made by a medical professional.
  • Cash Practice: This seems to be the route that many therapists follow. What it entails is that the therapist does not submit claims directly to the client’s medical aid. The client has to pay the invoice (cash, eft or credit card) and then they will receive a paid invoice or a receipt that they then submit to the medical aid. The medical aid will reimburse the client directly (if there are funds available). The reason why many therapists choose this option is to eliminate situations where they claim from the medical aid and then only realise that there are insufficient funds available. Therapists therefor place the responsibility on the client to make sure that there are funds available. Each practice has their own payment schedules and this should be discussed with the therapist or the accountant of the practice. Some therapists will consider cash discounts when approached by clients. Therapists are however under no obligation to agree to discount.
  • Medical Aid Claims: With this option the therapist submits claims directly to the medical aid. Any amount that the medical aid does not cover will be for the client’s own account.
If you are unsure of any of the codes or details on your invoice, please ask your therapist to explain it to you, instead of just having ‘expensive experiences’.

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