Additionally each practice has developed its own combinations of particular idiosyncrasies, which stand out as individual billing fingerprints. Wide variation occurs in the billing of the same test or group of tests amongst different practices, without differences in the applied technologies to perform the test. It should be stated at this stage that the introduction of CPT4 in the near future would not alleviate the foregoing problems as the CPT4 construction for South Africa is flawed with the transfer of most of the gazette defective billing into the SAMA CPT4 compendium. The current issue for 1999 is in our possession. The following is a brief overview of some of the billing styles, which comprise overservicing, fraudulent billing, or both.
American terminology is in bold italics .
Laboratories automatically reflex on the computer system extra tests that are not indicated on the request form. These extra tests do not comply with NPG guidelines. The upcoding of Histology and Cytology accounts It is of concern to Veripath that the annual tariff negotiations appear to have legitimised certain anomalies that have been in place for some years .It would appear that the tariff negotiations between BHF and NPG have not been successful for either funders or their members in reducing the cost of pathology tests as has occurred internationally. We believe that currently the NPG specifically and pathologists generally have detailed knowledge of Veripath s existence and function. However, it is possible that prior to Veripaths intervention many pathologists were not aware of the billing defects in their practices.