GP’s are Starting to Send Real-Time Claims

GP’s are Starting to Send Real-Time Claims


Medical aid claims

Towards the end of the year GP practices sent significantly more medical aid claims while patients were still at the practice (we refer to this as ‘ real-time claims ‘), with a peak in October. The reason for this spike seems to be financial. Most patients’ medical savings accounts (MSA) start running out in the last quarter of the year, meaning that more patients become personally liable for settling their accounts. Accordingly, practices’ collection efforts increase on a comparative scale.

Why real-time claims reduce the risk of potential bad debt

It’s logical to assume that practices want to find ways of managing this increased risk of potential bad debt. We believe that implementing the real-time claims behaviour is one way of avoiding this risk and more practices are realising this. A medical aid claim sent while the patient is still in the practice results in an immediate response from the medical aid, detailing what will be covered and how much must be settled by the patient. With this information, practices are informing patients before they leave the rooms of any possible liable amounts – because the sooner a patient is informed of any possible liable amount, the more likely they are to pay.

A pilot study launched to test the hypothesis of real-time claims

We tested this hypothesis in a pilot program where 42 practices were selected to participate. These practices were chosen due to their low real-time claims behaviour patterns. To demonstrate the benefits of real-time claims behaviour, their processes and the set-up within the practice were adapted to allow medical aid claims to be sent while the patient was still at the practice. Furthermore, the behaviour was monitored for a 4 week period.

Overall, the real-time claims habits of the practices changed significantly and this behaviour has remained ongoing across the majority of participants. In particular, one of our most impressive practices who adopted the entire process of real-time claims, together with the collection process, achieved around 66% reduction in his book debt.

As the trend indicates, there seems to be a similar motivation that practices in the wider market have cottoned onto and have subsequently started changing their claiming behaviour. Interestingly the trend of real-time claims behaviour was consistent across all provinces and all specialties including Dentists, Specialists, Optometrists and Auxiliary practitioners.

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