Update: A & L and NAPPI codes

Thank you for your responses to the claims and billing communication that we sent out earlier.

Below is more information on the typical format of accounts, list prices of NAPPI-coded products and facility fees.

Format of O&P accounts

Here is what the typical O&P account contains – please see below important advice on the charging of facility fees:

  • Professional and/or procedure fees
  • Component and materials costs
  • Facility fees.

List prices of NAPPI-coded products 

You can get access to the list prices of NAPPI-coded products by subscribing to a price file provider. These providers include Medprax, Mediscor, Scriptpharm and Medikredit. Before you make any decision, however, we strongly advise that you speak to your practice management software vendor. They would be able to tell you who their associated NAPPI file provider is.

Facility fees

There seems to be some uncertainty about the charging of facility fees. Here is what you should know:

  • You may determine your own facility fee. This fee is not regulated in any way.
  • Facility fees allow you to cover all of your overhead costs – not only components and materials. They are therefore an important part of your account. We advise you to apply these fees in such a way that you cover all of your practice costs.
  • The list prices that you pay for components and materials may differ from the cost price you are paying. As a result, you may find that the cost price covers your facility fees. This may prompt you to waive the facility fees – but keep in mind, once again, that the facility fees are not only meant for components and materials.
  • If members should decide not to charge facility fees, it would signal to the funding industry that no such fees are required. That would weaken our case in negotiating for the fees, meaning that no one would be able to recover any of their overhead costs.
  • PLEASE NOTE: Facility fees are not the same as a mark-up, margin or profit.  Facility fees allow you to recover the cost of procuring, handling, keeping in reserve and dispensing consumables and materials to your patients. Please let us know if schemes refuse to pay the facility fee. We are constantly engaged in talks with them, and actual examples together with full details would hugely help us to achieve the best outcomes for you.