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.
Lymphocytosis: Causes & approach to evaluation in adults
Lymphocytosis refers to an increase of peripheral blood lymphocytes, which for adults is defined as an absolute lymphocyte count (ALC) > 4.0 x 109 /L. Lymphocytes generally constitute 8-33% of white blood cell count (WBC) in peripheral blood. The normal number and distribution of lymphocyte subsets vary with age.
Platform change for urine cortisol analysis
Please take note of the platform change for 24 hour urine cortisol analysis.
This test will now be performed on the Abbott Architect immunoassay platform and will result in a change in reference interval to:
24 hr urine cortisol reference interval: 11.8 – 485.6 nmol/24 hours
Non-payment for syndromic PCR testing (BioFire FilmArray)
We write to you to keep you informed of developments within the medial scheme industry that affect the funding of some tests, specifically BioFire, used for diagnosis in acute respiratory diseases, suspected meningitis/encephalitis and diarrhoeal disease for the rapid identification of the pathogenic cause.
D-Dimer (UG/ML) Change of Method and specimen requirement
The D-Dimer test will be offered on the MINI VIDAS ®.
The report will state on which instrument the D-Dimer test result was obtained.
D-Dimer (NG/ML) Change of Method and specimen requirement
The D-Dimer test will be offered on the MINI VIDAS ®.
The report will state on which instrument the D-Dimer test result was obtained.
Flow cytometry for accurate detection and quantitation of fetal maternal haemorrhage
Transplacental or fetomaternal haemorrhage (FMH) may occur during pregnancy or at delivery and lead to immunisation to the D antigen if the mother is D negative and the baby D positive. This can result in haemolytic disease of the fetus and newborn (HDN) in subsequent pregnancies. It is important to assess the volume of FMH to determine the dose of anti-D immunoglobulin (anti-D Ig) required by a D negative woman to prevent sensitisation.
Diagnostic Testing for Autoimmune Liver Diseases
The autoimmune liver diseases include the triad of Autoimmune Hepatitis (AIH), Primary Biliary Cholangitis (PBC) and Primary Sclerosing Cholangitis (PSC). These conditions represent perhaps only 5% of all liver diseases, although the true prevalence in South-Africa is uncertain. Autoimmune liver conditions should be considered as a diagnosis after viral, metabolic and drug induced liver injuries have been excluded.
Porphyria Testing Update
The porphyrias arise from enzyme defects in the haem biosynthetic pathway. Accumulation of the precursors (ALA and PBG) lead to acute neurovisceral attacks, marked by severe abdominal pain and autonomic neuropathy, which may progress to a potentially fatal motor neuropathy.
Update on Laboratory testing of Ophthalmology Samples
Key considerations:A key issue is the small volume of sample that is available. It is not feasible to perform all tests on all samples whilst maintaining optimum sensitivity.Therefore, it is the clinician's responsibility to prioritise testing for each...