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The Namibian Registrar of Health Funds may not approve rules that impose restrictions on payments to health fund members.
The restrictions come after the Namibian Association of Medical Assistance Funds (Namaf) issued a notice to healthcare providers in the private sector: if patients do not use the ICD-10 coding system, health funds will refuse to file claims directly on their behalf.
In a statement, the Namibian Private Physicians Forum (NPPF) refuted the “extortion and coercive tactics” of the Namibian Private Physicians Forum and its funds, saying it was “deplorable” that the Registrar of Health Funds allowed such behaviour.
NPPF chief executive Dr Jurgen Hoffmann said the registrar’s role was to ensure all rules complied with the laws and regulations governing health funds.
“The newly imposed restrictions are not in compliance with the law,” he said.
Statutory authorization
Hoffman stressed that since its inception, Namaf has been ignoring its statutory duty to regulate health funds. He added that the association has also failed to develop a code of conduct to regulate health funds.
“Instead, Namaf continues to impose endless demands on health care providers in an illegal manner.”
Hoffman said the NPPF wanted registrars to recognise that unlawful restrictions on health fund payments had a direct negative impact on health fund members.
According to him, Namaf’s illegal practice was to force suppliers to bear the costs and provide services for free through extortion.
The burden on the private health sector
The ICD-10 coding system is a standardized system used by some governments to encode data on diseases and medical conditions. Because this data is only valuable to the government and health policy makers, countries that use this system support and compensate private healthcare providers to assist the government and policy makers.
However, this is not the case in Namibia, where Hoffman says the costs of training and ongoing data collection and submission – a huge additional administrative burden – must be borne by providers in the private healthcare sector.
“Since Namaf has no statutory power to force health care providers to use the system, it has now turned to the health funds to change their rules so that no payments will be made to any health care provider who does not use the ICD-10 coding system,” Hoffman said.
Applicable Law
He also mentioned that Namaf’s management consists of medical funds and therefore “is in no way different from Namaf itself”.
According to Hoffman, the Registrar of Healthcare Funds and the chief executive of the Namibian Financial Institutions Supervisory Authority (Namfisa) are believed to have approved amendments to all fund rules to force providers to use the ICD-10 coding system.
The NPPF has “implored” the Registrar to take all necessary steps under the law to ensure timely withdrawal of the amendments to the rules for enforcement of the service provider coding system.
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