Knowledge Hub
Categories:
- Allergy [1]
- Antimicrobials & infection [5]
- Autoimmune [1]
- Chemical Pathology [15]
- Endocrinology [1]
- Epidemiology [3]
- Gastrointestinal [2]
- Genetics [6]
- Genitourinary [2]
- Haematology [9]
- HIV/TB [3]
- Infectious Diseases [10]
- Neurology [4]
- Obstetric and Neonatal care [4]
- Oncology [1]
- Ophthalmology [1]
- Respiratory [2]
- Serology [3]
- Virology [44]
With regard to Designated Service Provider (DSP) Contracts the following law is pertinent for service providers who are not a DSP:
- In terms of Section 59 (2) of the Medical Schemes Act 131 of 1998 the medical scheme must pay valid invoices within 30 days of receipt thereof or advise both the member and service provider of reasons why the invoice is not valid and provide the opportunity to correct the invoice.
- Where services are in respect of medical emergencies or involuntarily obtained services for PMB conditions, the scheme has to pay for the full cost of the services provided without deduction or co-payment or limiting the tariff amount. (Regulation 8 (1) of the Medical Schemes Act no. 131 of 1998.)
- DOH notice 214 of 2021 requires that a scheme pays for services provided at the same rate and in terms of the same rules as they pay their DSPs in respect of services voluntarily obtained, whether they are PMBs or not.
- The process followed in respect of appointing a DSP is required to be fair, equitable, transparent, competitive or cost effective as required in terms of Notice 214 of the DOH.
In summary:
- The law protects the patient’s choice to use their laboratory of choice, even if it is not a DSP, and the scheme is still obliged to reimburse us at the scheme rate for valid claims.
- This is true for PMB conditions as well as non-PMB conditions.
- The medical scheme must pay valid invoices within 30 days or advise both the member and service provider of reasons why the invoice is not valid and provide the opportunity to correct invoice.
- A scheme must pay for the services provided at a tariff not less than what they would pay a DSP.
- Should any patient have a valid claim rejected because we are not a DSP, we can assist.
Update: BioFire Filmarray Syndromic Panels
Testing for respiratory pathogens using comprehensive multiplex molecular panels has become a valuable diagnostic tool to assist in early identification of causative organisms. Appropriate use supports timely and directed antimicrobial therapy, especially for organisms that cannot be cultured routinely (e.g Mycoplasma, Legionella, Chlamydophila, Bordetella and viruses); decreases in-hospital admission rate, length of hospital stay, and also assists in antimicrobial stewardship by avoiding the use of empiric antimicrobial agents.
Respiratory Virus Statistics: Jan – April 2022
The National Institute for Communicable Diseases declared the start of the respiratory syncytial virus (RSV) season in week 7 (week ending 20 February) and the positivity rate has continued to increase through March and April.
Typhoid/Salmonella Testing
Enteric fever includes typhoid fever (an infection caused by Salmonella enterica serotype Typhi) and paratyphoid fever (infections caused by Salmonella enterica subspecies enterica serotypes Paratyphi A, B or rarely, C) Paratyphoid fever is clinically indistinguishable from typhoid fever and the diagnosis and clinical management is identical. In South Africa, enteric fever is a notifiable condition with epidemic potential.
Primary Aldosteronism: An Under-Recognised Problem
Primary aldosteronism (PA), also known as Conn’s syndrome, is common and has a significantly higher cardiovascular risk profile than sex-, age-, and BP-matched patients with essential hypertension. PA is now considered a major public health issue, which requires a concerted effort at case detection through screening, followed by targeted care.
Indeterminate COVID results
The polymerase chain reaction (PCR) test for the detection of SARS-CoV-2 in respiratory specimens is an essential tool in screening and diagnosing COVID-191. Clinical virology laboratories often make use of a diverse repertoire of testing platforms with varying performance characteristics. The high analytical sensitivity of PCR assays often results in low-level detections.
Hyperuricaemia and Gout: Important Lessons to be Learnt
Gout is a common clinical disease and, furthermore, it is readily treatable and managed by the long-term use of urate lowering medication. Gout, the clinical syndrome, needs to be distinguished from hyperuricaemia which refers to the increased levels of serum urate.
Frequently asked questions: SARS-CoV-2 B.1.1.529/Omicron variant
On 26 November 2021 the WHO designated the new SARS-CoV-2 lineage B.1.1.529, now named Omicron, a variant of concern.
Much is still unknown about Omicron and it is expected that the variant’s real world impact will become clearer over the next weeks.
Covid-19 associated pulmonary aspergillosis (CAPA)
In individuals with co-morbidities, defective immune responses to SARS-CoV-2 may allow unrestricted viral replication which elicits hyperinflammation and severe complications such as acute respiratory distress syndrome (ARDS).
COVID-19 resulting in ARDS has recently emerged as an important disease that predisposes patients to secondary pulmonary aspergillosis.
Advances in molecular oncology: Liquid biopsy for non-small cell lung cancer
In recent years, liquid biopsies have emerged as a promising tool in the fields of molecular oncology and precision medicine. Liquid biopsy methodology typically analyses genomic DNA isolated from circulating tumour cells (CTCs) or circulating cell-free tumour DNA (cfDNA/ctDNA) in a peripheral blood sample, to gain insight into the genomic profile of the patients’ tumour.