Compensation for Occupational Injuries and Diseases Act, 1993 (Act No. 130 of 1993)

Private Acute Hospitals (Practice Type 057 and 058)

Tariff Codes

Code

Code Description

RAND

1.

General Wards

H001

Surgical cases: per day

4362.78

H002

Thoracic and neurosurgical cases (including laminectomies and spinal fusion): per day

4362.78

H004

Medical and neurological cases: per day

4362.78

H007

Day admission which includes all patients discharged by 23:00 on date of admission

1794.03

1.1

Special Care Units

Hospitals shall obtain a doctor's report stating the reason for accommodation in an intensive care unit or a high care ward from the attending medical practitioner and such report including the date and time of admission and discharge from the unit shall be forwarded to the Fund together with the invoice.

Pre-drafted and standard certificates of authorisation will not be acceptable.

H201

Intensive Care Unit:  per day

26658.59

H215

High Care Ward:  per day

13757.07

2.

Theatres and Emergency Unit

2.1

Theatre and Emergency fees are inclusive of all consumables and equipment. The after hours fee are included in the normal theatre fee

Rule: Emergency fee - excluding follow-up visits

H301

For all emergencies including those requiring basic nursing input, e.g. BP measurement, urine testing, application of simple bandages, administration of injections

1006.21

H302

For all emergencies which require the use of a procedure room, e.g. for application of plaster, stitching of wounds.

2041.39

H303

Follow-up visits: The Fund will reimburse hospitals for all materials used during follow-up visits. No consultation or facility fee is chargeable. The account is to be billed as for fee for service.

-

H105

Resuscitation fee charged only if patient has been resuscitated and intubated in a trauma unit.

7988.33

2.2

Minor Theatre Fee

A facility where simple procedures which require limited instrumentation and drapery, minimum nursing input and local anaesthetic procedures are carried out.

No sophisticated monitoring is required but resuscitation equipment must be available.

The exact time of admission to and discharge from the minor theatre shall be stated, upon which the minor theatre charge shall be calculated as follows:

H071

Charge per minute

121.23

2.3

Major Theatre

The exact time of admission to and discharge from the theatre shall be stated, upon which the theatre charge shall be calculated as follows:

H081

Charge per minute

358.73

3.

Prosthesis

Prosthesis Pricing:

Note:

A ceiling price of R1640.87 per prosthesis is included in the theatre tariff. The combined value of all the components including cement in excess of R1640.87 should be charged separately.

A prosthesis is a fabricated or artificial substitute for a diseased or missing part of the body, surgically Implanted, and shall be deemed to include all components such as pins, rods, screws, plates or similar items, forming an integral part of the device so implanted, and shall be charged as a single unit.

Reimbursement will be at the lowest available manufacturer's price (inclusive of VAT).

H286

Internal Fixators (surgically implanted)

-

Reimbursement will be at the lowest available manufacturer's price inclusive of VAT.

Hospitals I unattached operating theatre units shall show the name and reference number of each item.

The suppliers' invoices,each containing the manufacturer's name, including the components specified should be attached and appear on the medical Invoice.

External Fixators

Reimbursement will be at 33% of the lowest available manufacturer's price inclusive of VAT.

3.1

Medical artificial items (non-prosthesis)

Hospitals I unattached operating theatre units shall show the name and reference number of each item.

The suppliers' invoices, each containing the manufacturer's name, including the components specified should be attached and appear on the medical Invoice.

H287

Examples of items included hereunder shall be art ficial limbs,wheelchairs, crutches and excretion bags.

Copies of invoices shall be supplied to the Fund.

Reimbursement will be at the lowest available manufacturer's price inclusive of VAT.

Further Non-Prosthetic Medical Artificial items:

-

4.

Serious Burns

Billed at normal fee for service.

The following items are applicable and must be accompanied by a written motivation from the treating doctor.

H289

Serious Burns: Fee for service (Inclusive of all services e.g. accommodation, theatre, etc.) except medication whilst hospitalised.

-

H290

Serious Burns: Item for medication used during hospitalisation excluding the TTO's.

-

Note : TTO's should be charged according to item H288

5.

Psychiatric Hospitals (Practice Type 055)

H008

General Ward for Psychiatric Hospitals.

3398.80

6.

TTO

H288

TTO issued at discharge will be reimbursed by the Fund.

-

7.

Acute and Sub-Acute Rehabilitation

Rules

This Rehabilitation plan must be submitted to Fund when requested.

7.1

Acute Rehabilitation Hospitals (Practice Type 059)

General Ward

7.1.1

General ward for Rehabilitation Hospitals

All patients transfered from Acute hospital 57/58, Acute Rehabilitation (practice 59)or Sub-acute Rehabilitation (practice 49),a referral letter is required from the treating doctor.

H010

General rehabilitation ward per day

7288.19

7.2

Sub-Acute Rehabilitation Hospitals (Practice Type 049)

Admission to the facility should be referred by the treating principal or primary doctor.

Private sub-acute facilities shall indicate the exact time of admission and discharge on all invoices.

Employees of the sub acute facility are not allowed to-submit their own individual claim/s.

H020

Sub-Acute Rehabilitation ward per day

3977.01

8.

Frail Care / Palliative / Hospice (Practice Type 079)

Rules

8.1

General Ward

H950

Frail care / Hospice ward (Daily) (inclusive fee: ward fee, general care management, Doctors, Nursing staff)

2312.24

H955

Home health care, per visit

552.57