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.
Western Cape Province Antimicrobial Surveillance Data
We are presenting here the PathCare susceptibility data for common hospital-acquired organisms isolated from blood cultures from patients in the Western Cape Province over the last 2 years.
Myasthenia Gravis Autoantibody Profile
Myasthenia Gravis (MG) is an autoimmune neuromuscular disorder mediated by autoantibodies that target functionally vital proteins in the post-synaptic membrane at the neuromuscular junction.
Pitfalls in laboratory confirmation of South African tick bite fever
During the month of January 2023, PathCare confirmed a number of Rickettsia infections although both serological confirmation as well as PCR confirmation have significant limitations.
Measles Outbreak 2023: Important Reminders
Measles is one of the most contagious human pathogens known. Since late 2022, MV outbreaks have been declared in 5 provinces, namely, Limpopo, Mpumalanga, North West, Gauteng and Free State.
DPYD Result Interpretation
DPYD, the gene encoding dihydropyrimidine dehydrogenase (DPD) is the rate-limiting enzyme for fluoropyrimidine catabolism. In the context of 5-fluorouracil, four decreased function DPYD variants are of primary relevance due to their population frequency and established impact on enzyme function and toxicity risk1.
Respiratory Virus Statistics: 2022 Summary
Influenza A, influenza B and respiratory syncytial virus (RSV) returned to the characteristic seasonal circulation having shown atypical patterns in 2020 and 2021.
Adult Immunisation
The recent COVID-19 pandemic renewed the focus of the role of vaccination in the prevention of infection across all ages and in all communities.
October Respiratory Virus Statistics
The positivity rates for SARS-CoV-2 increased to the 15-20% range during October. It must be noted that the number of tests performed for SARS-CoV-2 remains low and the NICD has reported no significant increase in hospitalizations during this period.
September Respiratory Virus Statistics
National data showed influenza A positivity rates remaining around the 10% level during September, while influenza B continued to increase compared to August.