Professional Services
New reimbursement and compensation formulae, billing guidelines and managed health care compliance requirements are just a few of the forces that continue to impact the business of medicine. And while we provide a wide range of market leading professional healthcare management services - Our particular focus is on the fundamentals of supporting and maintaining a sound professional medical business practice for our members - and this is where we deliver the most value. Key to our success is that we have a full time, highly skilled, and dedicated healthcare team who form part of the network members extended practice to create a support structure through the transfer of knowledge, skills, and practical management solutions, providing members with the timely and responsive service they need and the high degree of professional contact they deserve.
Healthcare Help Desk Resource Centre The Help desk resource centre is backed by dedicated full time professional medical doctors and clinical nurse case managers to assist members and their practice staff on medical aid re-imbursement, coding, pre-authorisations, medical aid liaising, and clinical management enquiries. We offer: Professional support and assistance to accurately code for services rendered. Assisting on all ICD-10, NHRPL, and CPT code enquiries Professional coding assistance supprt to expedite billing of backlogged accounts and coding of difficult diagnosis and procedures Professional practical advice and support to maintain and update you on all changing billing regulations and coding policies Professional support on the handling of complicated and difficult PMB claims which cannot be resolved with medical aids Professional support and assistance on Pre-authorizations Professional support through dedicated channels within medical aids to assist with difficult administrative and clinical specific enquiries
SpesPractice - Practice management services First in South Africa. The first fully comprehensive Private Medical Aid plans benefit and reimbursement search engine through the SpesPractice member resource centre A medical Specialist provider practice contracting analysis review through the SpesPractice member resource centre with administrative backup and call support services Up to date medical aid preferred provider and DSP contracted reimbursement tariff offers through the SpesPractice member resource centre NAPPI code search engine through the SpesPractice member resource centre
SpesPractice - Practice Management Support tools Specialty specific ICD-10 coding desk reference manuals and software applications 3rd Edition Prescribed Minimum Benefit (PMB) desk reference manuals Medical - legal Doctor / Patient practice contracts Point of Sale credit and debit card practice terminals Practice / Patient communication support service tools
Managed Medical Healthcare Services Department A dedicated professional medical support services department which will assist and give advice to members and their practice staff on medical scheme reimbursement and billing policy procedures, clinical managed care intervention management policy, and advice and practice support on medical legal forensic investigations
Dedicated Professional Medical care Business Development team Who identify and track global and local health care market trends and engage with all key role players within the market e.g. medical schemes, hospital networks, and medical provider groups to identify and provide healthcare delivery service solutions and opportunities to members with integrated healthcare administration management solutions.
Professional Coding Management Training At SpesNet we understand that accurate coding requires not only training at all levels of a practice, but maintaining current knowledge and adaptation to changing billing regulations and coding updates as well. Our market leading professional clinical coding team will present you with a comprehensive and practical hands-on approach which will cover all aspects of professional coding needs in practice. Most importantly they will show you how to develop a professional coding accuracy standard for your practice as well as the support services and tools available which will give you the ability to accurately code for services rendered and to ensure compliance. Other topics covered: Claiming for Injury on duty (COIDA) patients Coding difficult diagnosis 4th and 5th character subcategories in conditions Mapping External cause codes Professional Practice fee setting Medical - Legal policies and procedures in practice Click on the SpesNet MPTG tab on the home page for more information.
Dedicated Professional in-field Practice Support Advisors Provide personalized professional support services to both the doctor and his/her practice staff Professional assistance and advice in practice management reviews Professional assistance and advice on medical aid DSP and preferred provider contracting Keep members regularly updated on Healthcare market updates and trends Professional assistance and advice on business practice support services and tools
IOD@SpesNet - If you need more information, please click on the link below. IOD@SpesNet Information Sheet (184kb)