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

Scale of Fees

Annual Increase in Medical Tariffs for Medical Service Providers - 2023

Ambulance Gazette 2023

Ambulance Tariff of Fees as from 1 April 2023 (Practice Type 09)

General Rules

 

RULE

DESCRIPTION

001

Road ambulances: Long distance claims (items 111, 129 and 141) will be rejected unless the distance travelled with the patient is reflected. Long distance charges may not include item codes 102, 125, 127, 131 or 133. Long distance claims (items 112, 130 and 142) to be rejected unless the distance is reflected.

 

 

002

No after hours fees may be charged.

 

 

003

Road ambulances: Item code 151 (resuscitation) may only be charged for services provided by a second vehicle (either ambulance or response vehicle) and shall be accompanied by a motivation. Disposables and drugs used are included unless specified as additional cost items (see below).

 

 

004

A BLS (Basic Life Support) practice (Pr. No. starting with 13) may not charge for ILS (Intermediate Life Support) or ALS (Advanced Life Support); an ILS practice (Pr. No. starting with 11) may not charge for ALS. An ALS practice (Pr. No. starting with 09) may charge for all codes.

 

 

005

A second patient is transferred at 50% reduction of the basic call cost.

Rule 005 MUST be quoted if a second patient is transported in any vehicle or aircraft in addition to another patient. Refer to Aeromedical transfers section 5.

 

 

006

Guidelines for information required on each COIDA ambulance invoice:

 

Road  and  air ambulance invoices

• Name and ID number of the employee
• Diagnosis of the employee's condition

The date on which the service was rendered

• Summary of all equipment used if not covered in the basic tariff

Summary of medical procedures undertaken on patient and vital signs of patient

• Name, practice number and HPCSA registration number of the medical doctor
• Response vehicle: details of the vehicle driver and the intervention undertaken on patient
• Place and time of departure and arrival at the destination as well as the exact distance travelled (Air ambulance: exact time travelled from base to scene, scene to hospital and back to base). Road Ambulance: exact time travelled from base to scene, scene to hospital)
• Details of the trip sheet should be captured in a medical report provided for on the COID system.

 

Definitions of Ambulance Patient Transfer

Basic Life Support - A call out where the patient assessment, treatment administration, interventions undertaken and subsequent monitoring fall within the scope of practice of a registered Basic Ambulance Assistant whilst the patient is in transit.

Intermediate Life Support - A call out where the patient assessment, treatment administration, interventions undertaken and subsequent monitoring fall within the scope of practice of a registered Ambulance Emergency Assistant (AEA), e.g. initiating IV therapy, nebulisation etc. whilst the patient is in transit.

Advanced Life Support - A callout where the patient assessment, treatment administration, interventions, undundertaken and subsequent monitoring fall within the scope of practice of a registered paramedic (CCA and NDIP) whilst the patient is in transit.

NOTES

• If a hospital or doctor requires a paramedic to accompany the patient on a transfer in the event of the patient needing ALS / ILS intervention, the doctor requesting the paramedic must write a detailed motivational letter in order for ALS / ILS fees to be charged for the transfer of the patient.
• In order to bill an Advanced Life Support call, a registered Advanced Life Support provider must have examined, treated and monitored the patient whilst in transit to the hospital.
• In order to bill an Intermediate Life Support call, a registered Intermediate Life Support provider must have examined, treated and monitored the patient whilst in transit to the hospital.
• When an ALS provider is in attendance at a call out but does not do any interventions on the patient at an ALS level, the billing should be based on a lesser level, dependent on the care given to the patient. (E.g. if a paramedic sites an IV line or nebulises the patient with a B-agonist which falls within the scope of practice of an AEA, the call is to be billed as an ILS call and not an ALS call.)
• Where the management undertaken by a paramedic or AEA falls within the scope of practice of a BAA the call must be billed at a BLS level.

Please Note

• The amounts reflected in the COIDA Tariff Schedule for each level of care are inclusive of any disposables (except for pacing pads, Heimlich valves, high capacity giving sets, dial-a-flow and intra-osseous needles) and drugs used in the management of the patient, as per the attached nationally approved medication protocols.
• Haemaccel and colloid solution may be charged for separately.
• An ambulance is regarded by the Compensation Fund as an emergency vehicle that administers emergency care and transport to those employees with acute injuries and only such emergency care and transport will be paid for by the Compensation Fund. A medical emergency is any condition where death or irreparable harm to the patient will result if there are undue delays in receiving appropriate medical treatment.
• Claims for transfers between hospitals or other service providers must be accompanied by a motivation from the attending doctor who requested such transport. The motivation should clearly state the medical reasons for the transfer. Motivation must also be provided if ILS or ALS is needed and it should be indicated what specific medical assistance is required on route. This is also applicable for air ambulances.
• Transportation of an employee from his home to a service provider, this includes outpatients between two service providers, if not in an emergency situation, is not payable. In emergency cases such transport should be motivated for and the attending doctor should indicate what specific medical assistance is required on route.

Claims for the transport of a patient discharged home will only be accepted if accompanied by a written motivation from the attending doctor who requested such transport, clearly stating the medical reasons why an ambulance is required for such transport. It should be indicated what specific medical assistance the patient requires on route. If such a request is approved only BLS fees will be payable. Transport of a patient for any other reason than a MEDICAL reason, (e.g. closer to home, do not have own transport) will not be entertained.