shafeeqah@emconline.co.za

1. Advanced Practice Management
Session
Either You Are Managing Your Practice
Or It Is Managing You!
Dr Sugen Naidoo MB.Ch.B, MBA
Fudley Bezuidenhout Pr.Eng.
EMC Practice Management

2. Introduction
• Who are we?
• Who are you?
• What we aim to achieve
together today

3. Agenda of this Session
Practice Management consists of many facets. For purposes of
today’s session we will be restricting ourselves to:
• Philosophy of EMC Practice Management
• Current situation in Emerging Healthcare
• Ownership culture and leadership
• Patient wellness and risk management
• Chronic burden of disease management
• Guidance around procurement and Data
• Claims management
• Medicine and material pricing
• Practice management support

4. Philosophy of EMC Practice
Management
To create value for participating
network practice managers

5. Cash Flow Stress
Admin Burden Low Patient Numbers
P Poor time management
SYMPTOMS
R Costly mistakes Blame culture
Implementation
O challenges
No or limited planning
B Limited Support
L Resistance to change
CAUSES
E
Low Morale
M
Lack of Trust

6. Project Scope for Enrolment
The SOLUTION
Ownership culture
Aligned Financial Incentive
THE PRACTICE MANAGEMENT UNIT PROVIDES THIS
CRUCIAL ELEMENT
Provider Undertaking Union and Associations Leadership
RESPONSIBILITY, ACCOUNTABILITY AND DELIVERY
TAKE THE ROAD LESS TRAVELLED EMC PC:
DSP
MANAGE THE PROCESS
CONTROL THE WORK LOAD
FOCUS ON MEASURABLE OUTPUTS
Healthcare Providers
Patients from unions and associations
BE SMART
Provider Contract

7. The Practice Manager to Lead

8. Patient wellness and risk
management
• Screen high risk patients
• Perform health risk assessments
• Prepare for NHI community based care

9. Chronic burden of disease
management
• See your patient every quarter
• Track clinical indicators and measurable
outcomes
• Ensure medication compliance

10. Guidance around Procurement and
Data
• Sale of anonymised data is allowed
• Marketing code of conduct
• Abundance mentality
• Arrangements are in place
• Corporate groups are doing this

11. Claims Management
What is a Claim? An encounter with a
Patient we have not yet been Paid for.
For purposes of this session we will
be looking at …
• Claims Submission
• Claims Follow-up / Tracking
• Remittance Input
• Debt Management

12. Claims Formulation
and Submission
Who will be responsible for settling the
Claim? What are their requirements?
• Medical Aid
• Patient/Member e.g. private
• 3rd Party e.g. WCA, Insurers
• Other e.g. Employer/Union

13. Claims
Setup/Follow-up/Tracking
Why do we do this? To get paid, of course!
Surprise: only done by 2% of practices.
• Claim tracking spreadsheet
• Encounter date, medical aid, dependent,
ICD10, claimed amount, date submitted, how
submitted, date of payment expected
• Follow-up: minimum once a week
• Use colours, e.g. green -> orange -> red

14. Remittance Input
Getting paid is Everything. Cashflow is How
we get paid. If we run out of money to pay our
expenses, we’re technically bankrupt.
• Handling rejections, resubmissions, look for
patterns, when to fight, when to capitulate
• What is your practice’s write-off policy
• What to do with Balances remaining
• Filling remittances: received by email,
received by snail-mail
• Master the art of capturing in your PMA

15. Debt Management
A well-run practice has a predictable
cashflow, humming back-end, and
produce a fulfilling patient experience.
• Know your numbers: what you measure you can manage
• Aged analysis breakdown, debtor days, aged account ratio
• Trigger points: clean Aged Analysis, prelude to delinquency, about-to-
become-stale accounts, bad debt handover, prescription of debt
• Schedule tasks: days of the month, or days of the week
• Track activities and conversations for reporting and/or follow-up. Use your
computer
• Be empathic but persistent, understanding yet ruthless, warm yet non-
personal
• Outsource: Debt collection, hand-over debts, WCA / COID claims, Legal
Action

16. Medicine and Material
Price Updates
Hidden treasure in many
dispensing practices
• SEP: Single Exit Prices. Determined by the Government. Based
on NAPPI code.
• Practice (doctor) is allowed a dispensing fee
• Markup: 30%, Threshold: R78, Max: R23.40
• Where to find the latest ruling prices? EMC Online
Membership-based Web Portal
• How to ensure that you are charging out the correct prices
within your PMA
• In our experience it is possible to increase income from
dispensing medicines by 10% using price updates

17. E.g. Online Check Price of Histalix

18. Practice Management Support
Day-to-Day Practice Stress: How to
Balance the Power between your
Practice, Patients and Medical Aids
As doctors struggle with prolonged poor
market conditions the heightened stress is
taking its toll. EMC PM Support is the answer.
• Pay-as-you-go, month-by-month basis. Quick easy sign-up.
• Online ICD lookup
• Online medicine and material price lookup
• Online chronic disease management
• Online medical aid contact details and information/communication portal
– all in one place
• Online “closed” classifieds: locums, staff finder, job adverts, medical
equipment for sale
• Online “closed” moderated bulletin board where you can share
information (e.g. bad payers, etc) , tips and tricks, seek advice
• Remote PMA support.
Only R200/month ex. VAT
Email: shafeeqah@emconline.co.za Fully Tax Deductible

19. Your first month’s support
(April 2012) is FREE
Online ICD10 Lookup Online
Classifieds
Online Chronic Disease Management
Find Locums and Staff
Up-to-date Medical Aid Info
Online Medicine and Material Lookup
With NAPPI Codes
Secure Web Portal – Join our community
Access from Anywhere
Only R200/month ex. VAT Email:
Fully Tax Deductible shafeeqah@emconline.co.za

20. Thank You for Attending
QUESTIONS?