Health Focus

Eminance compliance making your life easy

Of course it's important to us that your VAT report balances with your returns, or that your stock holding reconciles. After all, that's what a basic practice management system should do.

But we go one step further. We study the law to make sure that all facets of our program comply, thereby ensuring that without you even knowing, you comply. Designed into our specifications, it's just one more way that we offer you complete peace of mind.

 

 

 

What the Act Says	How Eminance Helps
If a medical scheme provides benefits to its members by means of a managed health care agreement with another person, it must be in writing	Health Focus allows you to create a template agreement, mail merging the medical aid details with the patient details.  Once the template has been created, it's a simple click on the button.
The arrangement or agreement must ensure that no member or dependant of a member is held liable by the participating provider for any sums owed by the medical scheme or any other person.	The allocation screens allow you to transfer the patient liable to the medical aid liable, and to submit the claim either via EDI or on a paper statement.
An agreement or arrangement between a medical scheme and a provider of a managed healthcare service must require either party to give at least 90 days advance notice before terminating the agreement.	The Medical Aid table allows you to tag the medical aid, and to set an expiry date.  All balances owed by the patient can then be transferred to the patient liable account.
A medical scheme shall not enter into any contract where a provider of a relevant health service is forbidden in any manner from informing patients of the care they require, including various treatment options, and whether in the provider’s view, such care is consistent with medical necessity and medical appropriateness.	Health Focus products allow you to record the diagnosis per patient, and allows you to generate reports based on these diagnosis.
A medical scheme shall not terminate a contract with a provider, nor shall it enter into an agreement with any other person that allows for such termination, because the provider expresses disagreement with a decision to deny or limit benefits to a member.	Health Focus products allow the tagging of a patient, as well as a global facility for write offs and transfer to patient liable.  Advance settings allow the tagging of medical aid changes, and printing statements accordingly.
Where a medical scheme or any other person who provides a managed healthcare service to a medical scheme proposes to terminate a provider’s contract, the notice of termination must include the reasons for the proposed action; a notice that the provider has a right to request a hearing or review, at the provider’s discretion, before an impartial panel appointed by the Council for Medical Schemes.	The clinical notes allow a recoding per encounter, linked to a date as well as a tag reminder.  Clinical notes allow an unlimited amount of encounters per patient.
The panel must give a decision within three days of such hearing, and must communicate the decision to the provider, and the decision must include reinstatement subject to conditions set forth by the panel or termination of the provider’s contract.	The patient notes allow an immediate view of the status of the account, and panel decisions and pending information can be retained on the members file.  The account ID code allows for groupings of this nature, and the reporting of the status.
A medical scheme may not use a financial incentive that directly or indirectly compensates a provider for ordering or providing services that are less than appropriate care to, his or her patients.	Up to 12 billing rates are provided, allowing you to consistently bill the correct amount negotiated with the funder.  In turn, each medical aid can have one of these default billing rates.
Any information pertaining to the diagnosis, treatment or health of any member of a medical scheme or of any dependant of such member must be treated as confidential.	The password control area allows strict control of access rights.
A medical scheme is entitled to access any treatment record held by the provider and other information pertaining to the diagnosis, treatment and health status of the member in terms of the agreement or arrangement, but such information may not be disclosed by the provider to any other person without the consent of the member, except for purposes of notification as stipulated in the relevant Act or regulations.	The built in e-commerce and e-mail systems allow immediate sending of information.  Hospital admissions are encrypted to ensure a high level of security.  Tagging of consent is held in the patient file.
A medical scheme may not prohibit, or enter into a contract that prohibits the initiation of an appropriate intervention by a provider prior to receiving authorisation from the medical scheme or any other party, where a person presents with any condition that requires immediate medical or surgical intervention. Any decision to deny coverage shall be made by a qualified doctor and after consultation with the attending doctor.	Tagging of referred to or referred by doctors is fully supported.