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Doctors question some middlemen’s new fee structures
 

Doctors question some middlemen’s new fee structures

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SINGAPORE — Ahead of new rules kicking in next month on fees that doctors may pay to middlemen who help process medical claims, concerns linger over whether some of the new fee proposals could land doctors in trouble with the medical watchdog. Most of the middlemen, called third-party administrators (TPAs), have sent doctors their new fee schedules in recent weeks. While percentage fees have been scrubbed out of the new schedules to fall in line with revised guidelines, doctors — who all spoke to TODAY on condition of anonymity — question if some of the proposals still contravene the rules in spirit. “There is still a sliding scale of administrative fees being applied to (the Ministry of Health’s table of surgical procedures, categorised by level of complexity). As to how the scale is derived, there is not much clarity or transparency,” a surgeon in private practice said. He may halt contracts with TPAs that are not clear enough, he added. Two of the five doctors who spoke to TODAY have decided to suspend or cut ties with certain TPAs, in order not to risk running afoul of the Singapore Medical Council (SMC), which regulates doctors but not TPAs. One TPA, for instance, is charging an administrative fee that is up to 5.5 times what another player is billing for certain surgical procedures. “It makes it hard to believe that (the TPA’s) fee is based entirely on the work done (in) processing a claim”, one surgeon said. Some fees amount to 25 per cent of what the doctor bills the patient, which is “quite aggressive”, he added. The doctors said that they may wait six months to a year to see if any of their peers gets into trouble with the SMC for engaging with any particular TPA, in order to get a clearer picture of what is allowed and what is not. This is in spite of some TPAs stating that their lawyers have given their fees the green light. Under new SMC guidelines, doctors are barred from paying TPAs fees that are calculated as a percentage of what the doctors charge their patients. Fees should reflect actual work done by the TPAs, whereas percentage fees reflect the work done by the doctor. Percentage fees may drive up costs for patients, the SMC has said. Doctors are also barred from paying TPAs fees that are so high as to constitute fee-splitting, or fees that compromise on the required standard of care for patients. While the SMC’s new ethical code and ethical guidelines for doctors took effect on Jan 1 this year, the council allowed the rules on doctors’ TPA fees to take effect from July 1, to give them time to modify or terminate existing arrangements. Should they cut ties with a TPA, doctors said that they would hand the care of affected patients over to another doctor remaining on the TPA’s panel. A surgeon said that his patients who are covered by insurance from their own employers could also pay him out of their own pockets before claiming from their own management. TPAs said that their fees are based on the complexity of the medical claims and the operating and business-support costs involved. Parkway Shenton’s chief executive-designate Adrian Lee, whose firm is charging administrative fees of S$100 to S$1,000 for specialists’ inpatient cases, said: “For inpatient transactions, the amount of work and time spent on adjudicating and processing each claim varies significantly, depending on the complexity of the procedure and bill size.” Mr Lee said that Parkway Shenton’s new fee schedule would result in lower administrative fees for doctors overall. Its panel of general practitioners has responded positively to its fixed rates of S$3.50 per transaction, as well as the TPA’s pledge to waive admin fees of such clinics that see fewer than 180 patients through Parkway Shenton per year, he added. Fullerton Health has broken its fees down into three categories: Technology; network administration; claims processing and contact centre management. The last category varies in complexity and amount of work — and qualifications of staff members — involved. Group deputy chief executive and co-founder Daniel Chan said that Fullerton Health’s network engagement team would follow up with doctors over the coming months to address any further queries. Dr Low Lee Yong, chief executive of MHC Asia Group, said that its outpatient admin fees are fixed and itemised for consultation, drugs, procedures, laboratory and X-rays. Its inpatient admin fee for specialists starts from S$20 for less complex procedures (Category 1A) and are capped at S$180. MHC sent its new fee schedule to doctors on June 2 and Dr Low said that the response has been “overwhelming”, with almost one-quarter of its network of more than 1,200 private clinics already signed up. “We are confident of getting our panel signed up by June 30,” he said. Other TPAs in Singapore include IHP, Vista and Alliance Medinet. Explaining why he decided to continue working with MHC, a general practitioner said: “I get a fixed fee, which is what it’s supposed to be. I don’t see anything that’s below board.” He added: “The best scheme is if the doctor wins, the patient wins, and the TPA wins… TPAs are an integral part of our healthcare system to manage costs for companies and, the economy being in its current state, we definitely want to be able to support them if they’re fair to doctors.”
 
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13 Jun 2017 - General