FAQS
A. Contracts:
1.How does one participate in the Bankmed GP provider Network?
A GP has to sign both, the Bankmed GP provider contract together with the IPA Foundation Provider (whether they belong to a local IPA organisation or not) contract in order to belong to the Bankmed GP Provider Network.
2.Can a GP, who is not a member of any local IPA join the Bankmed network?
Yes. Any willing GP can join, whether they belong to a local IPA or not, as long as they sign both the Bankmed GP provider and the IPA Foundation contracts.
3.Will there be any profiling and peer review?
The IPA Foundation will perform the profiling and peer review as part of their network management services and as a requirement of the contracts signed.
4.Who is a Contracted IPA member?
- All willing GPs can sign the Bankmed and the IPA Foundation contracts, whether the GP belongs to a local participating IPA
or not.
- If the contracting doctor is a member of one of the participating IPAs (SAMCC, ASAIPA or SpNET), then the doctor will be
registered as a Contracted Bankmed GP provider who is also a member of the participating IPAs.
- If the GP is not a member of one of the participating IPA's or a member of an IPA who is not participating in the IPA
Foundation, then the doctor will be registered as a Contracted Bankmed GP provider who is not a member of the participating
IPAs.
5.Does the doctor have to sign the IPA Foundation contract in addition to the Bankmed GP provider contracts?
This agreement is important if the GP wishes to participate in the Bankmed GP network. The IPA Foundation is facilitating the network for Bankmed as well as performing the Profiling and peer management functions.
This IPA Foundation contract is a once-off agreement between the Provider and the IPA Foundation. They will not need to sign this agreement again when the IPA Foundation contracts with another medical scheme.
6.Is Balance Billing allowed?
When the GP signs the contract for the enhanced reimbursement as well as becoming the nominated DSP for the primary care portions of the PMB conditions, balance billing will not be allowed, as per clause 3.1.4 in the contract.
7.When is the higher remuneration effective?
The contracts become effective on 1 January 2009. The addendum B of the contracts, as related to the completion of the Personal Health Assessment (PHA) questionnaires, is effective as soon as the practice is handed their usernames and passwords to access the PHA website.
8.How will the Core Saver option work?
Each beneficiary who is subscribed to the Core Saver option will have to choose a contracted GP as their nominated GP. They are only allowed to consult their nominated GP. This scheme plan allows for 2 acute consultations per annum. For each chronic disease that the beneficiary is registered for, there will be a basket of services authorised, such as further consultations, pathology, radiology and auxiliary services.
9.Does a group practice have to complete the forms for each partner individually or can they just complete one contract for the group practice?
Every doctor in the practice should sign the contract, and use their group practice number. This is their billing number and also to insert their HPCSA number on the contract.
10.Can a Provider bill after hours fees?
With regards to after hours billing, the following appears in the NRPL 2009 document, as rules governing the billing:
Rule B states:
Normal hours and after hours: After-hours services are paid at the same rate as benefits for normal hours services. Bona fide emergency medical services rendered to a patient, at any time, may attract a fee as specified in modifier 0011 and items 0146 or 0147 (which should be added to the appropriate consultative services code selected from items 0190-0192, 0173-0175, 0161-0164, 0166-0169)
11.Where can I send the completed contracts?
The completed and signed contracts can be forwarded to the IPA Foundation as follows:
- By dropping it off at the nearest participating IPA office "add hyperlink - IPA Contact details"
- By faxing it to 021 480 4455
- By posting the contracts to: Geraldine Dreyer,
- Provider Networks Coordinator,
- PO Box 15079,
- Vlaeberg,
- 8018
- Can be delivered by couriered to or dropped off at:Geraldine Dreyer,
- Provider Networks Coordinator,
- 61 St George's Mall,
- Cape Town,
- 8000
- Can be delivered by courier or dropped of at: Xolisa Morolo
- Provider Networks,
- Metropolitan Health Group,
- No 101 De Korte Street
- Braamfontein,
- Johannesburg
B. IPA Foundation (Foundation):
1.What is the IPA Foundation?
The IPA Foundation is a section 21 non-profit body comprising the 3 major IPA's, i.e. the SAMCC, ASIAPA and SpNet. This body aims to contract with medical schemes and perform network management, profiling and peer review services.
2.Why do the GPs have to sign the IPA Foundation contract?
In order for the Foundation to carry out its functions, there has to be a contractual relationship between the GP and the Foundation.
3.Does the GP have to belong to an IPA in order to contract with the Foundation?
Any willing GP can contract with the Foundation. Although the founding parties are IPAs, contracting with schemes is available to any willing GP and it is not a requirement to be a member of any IPA in order to contract with the Foundation.
4.How will the IPA Foundation conduct the Profiling and Peer Review?
The Foundation will conduct profiling, data analysis independent of any medical scheme and will perform the profiling with accredited and experienced doctors, again independent of any medical scheme.
5.Is the contract binding or can a GP resign at any stage?
Participation and contracting with the IPA Foundation is conducted on a willing basis and the GP may resign at any stage, with no adverse repercussions, subject to the contractual obligations as required in the contract.
6.Can the GP contract with other Medical Schemes, MCOs, outside the Foundation after contracting with the Foundation?
The GP can contract with any other organisation in addition to contracting with the Foundation. There are no limitations or restrictions placed on the GP.
7.Why is the GP, who is contracted to the Foundation and an IPA member, reimbursed higher?
GPs who are members of a local IPA organisation pay membership fees. These IPAs have used their resources - time, money and manpower, in order to negotiate this contract with Bankmed. While the contracts have been made open to all GPs, including the GPs not belonging to an IPA, the IPA members have a slight differential in order to recoup their original contribution.
8.Once contracting with the Foundation, does the GP have to join an IPA?
There is no obligation on the GP to join any IPA after contracting with the IPA Foundation. If the GP does join an IPA, then the IPA will inform the Foundation and the GP will then be registered as a Contracted Bankmed GP provider who is also a member of the participating IPAs, with the higher remuneration due.
