ISSUE NO. 19 JULY 2018 Frequently Asked Questions 5 3 Cimas introduces value addition benefits Optometry degree will impact on future generations 4 4 Cimas MEDLABS maintains commitment to quality and excellence 6 Engage Question of the Month?
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From the Editor s Desk The month of June was full of exciting events, a whirlwind some might say. A lot happened in that cold wintry month. Cimas management went around the country engaging members on various issues. Members who came to the meetings had their questions answered and received information on the Society s future plans. In this month s issue, we unveil some new initiatives. With effect from 1 July 2018 the Society has introduced a disease prevention and management benefit. Introduction of this benefit allows Cimas to proactively deal with major high cost diseases like cancer, diabetes and kidney failure. The Society also reviewed the spectacles renewal period from three to two years. We congratulate the Medical Laboratories on the reinstatement of its ISO 15189 Accreditation following recent renovations of the main laboratory to world class standards. The accreditation is a testament to the Society s commitment to continually improving on the service it provides. We value your feedback. You can forward your comments and queries to: publicrelations@cimas.co.zw, www.cimas.co.zw, Cimas connect, +263 772 161 829, www.facebook.com/cimasmedicalaid. Alternatively you can call us on (04) 777300-15. Cimas introduces value addition benefits A range of issues were discussed at the member engagement meetings Cimas held in Harare in May, at which members learnt about initiatives the Society is introducing this month. Cimas Medical Aid Managing Director Washington Madziwadondo told members the Society would be making available a preventative and disease management care benefit with effect from July 1, 2018. Preventative healthcare is the care provided to prevent illnesses or diseases. It includes counselling that is intended to prevent health problems. Providing these services at no cost is based on the idea that preventative measures such as screenings and immunisations can help one stay healthy. We are losing a lot of members to preventable diseases such as cancer, diabetes and hypertension, Mr Madziwadondo said. From 1 July your Society will cover you for tests such as pap smear and prostate cancer detection. For our hypertensive members, we have introduced a Managed Care Department. The department will be managing our chronic members. Very soon they will be calling you to discuss how you can live healthier lives, he added. The managed care system is about ensuring quality cost effective care for the member by promoting good outcomes. The Cimas Managed Care Department will conduct follow-up member engagement sessions and provide education on chronic ailments on an individual basis. Members will be advised what to expect from preventative care providers. Washington Madziwadondo - Managing Director, Medical Aid During the engagement Mr Madziwadondo also disclosed that Cimas had reduced the optical benefit renewal period to two years from the previous three years. Mr Madziwadondo implored members to desist from lending their Cimas membership card to others, as this is having a negative impact on the medical aid fund. Giving someone your card is like giving them an open cheque. When you give someone your card you are giving away your benefit. It becomes difficult when you need to use it most. Card lending is like insuring two people on one card, he said. The management team also visited various parts of the country in June to discuss fund performance and the introduction of more benefits for members. ISSUE NO. 19 JULY 2018 3
Optometry degree will impact on future generations C imas Medical Aid Society Board member Mr Bart Mswaka described the recent launch of the Bachelor of Science Optometry (Honours) degree at the University of Zimbabwe as a milestone, the impact of which would be felt by future generations of Zimbabweans. Speaking at the launch of the degree programme on 18 May 2018, he quoted Hellen Keller, one of the most famous visually impaired people in history, who once said: The only thing worse than being blind is having sight but no vision. It is heartening to see that the College of Health Sciences crafted this vision and then partnered with Cimas Medical Aid Society to ensure that it came to fruition, he said. Mr Mswaka said the Cimas Health Education UZ Optometry students together with Cimas executives Fund had supported the vision by sourcing and purchasing the optometry equipment used for the optometrists training and renovating the unit at Sekuru Kaguvi Hospital that houses the equipment. In doing so, it had demonstrated its commitment to a healthy nation and the alleviation of impaired vision. Impaired vision of varying severity is a significant disease burden in Zimbabwe. With the establishment of the optometry degree, the supply of qualified optometrists will increase significantly, he said. He added that, if most of the graduates practised optometry locally, this should result in a reduction in the number of cases of impaired vision. Cimas is proud to be associated with this milestone in the training of health scientists in Zimbabwe, he said. Mr Mswaka said that the Cimas Health Education Fund has, since its inception in 2007, sponsored 25 undergraduate students and 16 postgraduate students. Currently we have post-graduate students in the fields of paediatrics, haematology, histopathology, internal medicine, neurology, orthopaedics, radiology and cardiothoracic surgery. Total spend towards the fund in 2017 alone was $248 182. We assure you of our continued unwavering commitment to the relationship we have with the College of Health Sciences. Let us savour this moment and henceforth walk with our heads held high, knowing the future of eye care in Zimbabwe will never be the same again, said Mr Mswaka. Cimas MEDLABS maintains commitment to quality and excellence C imas MEDLABS is proud to announce its re-instatement to ISO 15189 Accreditation following the recent renovations of the main laboratory, during which the lab was on voluntary accreditation suspension as per the requirements of the accreditation authority (SADC Accrediting Service). What is ISO? ISO is an acronym for the International Organisation for Standardisation, which is an international body founded by governments around the world to publish standards which are recognised across the globe. ISO 15189 is the quality and competence standard which specifies the quality management system requirements specific to medical laboratories. What is accreditation? Accreditation is a procedure by which an authoritative body gives formal recognition that a body or person is competent to carry out specific tasks. It is used to verify that laboratories have an appropriate quality management system and can properly perform certain test methods according to the scope of their accreditation. Accreditation versus Certification Certification is used for verifying that personnel have adequate credentials to practice certain disciplines, as well as for verifying that products meet certain requirements. The ability to demonstrate technical competence is the major difference between accreditation and certification and puts accredited certification on a level above just certification. Cimas Medlabs has therefore gone beyond certification to accreditation. Passing the annual surveillances and the accreditation re-instatement assessment confirms that Cimas MEDLABS continues to conform to the highest international quality standards. ISSUE NO. 19 JULY 2018 4
Frequently Asked Questions Cimas is concerned at the number of fraudulent claims and their impact on the health insurance industry, which is experiencing losses amounting to $160 million annually as a result of fraud, errors and leakages. During a recent media engagement, the Cimas Chief Executive Officer, Mr. Vulindlela Ndlovu, told journalists that about $32 million worth of claims made by Cimas clients annually were fraudulent or had errors. It is against this background that we look at frequently asked questions concerning fraud. Q: What is healthcare fraud, waste and abuse? A: Healthcare fraud is an intentional violation of trust in order to secure personal financial advantage / turn a profit. Waste is over-utilisation of services and the misuse of resources. Abuse is excessive or improper use of services or actions that are inconsistent with acceptable business or medical practice. Q: What forms of healthcare fraud, waste and abuse are there? A: There are three types of fraud schemes. These are practitioner, member and employee perpetrated fraud schemes. Practitioner schemes include: billing by practitioners for care that they never rendered; filing duplicate claims for the same service rendered; altering the dates, description of services or identities of members or providers in order to claim at a higher tariff or to duplicate claims; billing for a non-covered service as a covered service (misrepresenting service actually rendered); modifying medical records; intentional incorrect reporting of diagnoses or procedures to maximise payment; use of unlicensed staff but claiming at licensed staff rates; accepting or giving kickbacks for member referrals; and prescribing additional or unnecessary treatment. Members can be guilty of healthcare fraud, waste and abuse by: providing false information when applying for benefits or services; obtaining subsidised or fullycovered prescription pills that are actually unneeded and then selling them on the black market for a profit; using the medical aid card for nonmedical related purposes; and lending their medical aid card to someone else or using another s medical aid card. Employees can commit healthcare fraud by demanding kickbacks for certain favours such as expedited claims processing or membership registration. Q: What is Cimas doing to stop fraud? A: Cimas produces regularly statements called Remittance Advices, detailing payments made to all providers that members would have consulted, and statements of refunds to members. If there are any irregularities on the statement, members should immediately consult their Society as there could be fraud involved. Some irregularities come about because of stolen membership cards or even misuse. Someone close to you may be using your card to access treatment without your knowledge. Cimas is also: raising awareness so that all stakeholders are able to identify and report fraud, waste and abuse to enable necessary action to be taken to safeguard the medical aid fund; and paying closer attention to claiming patterns to curb waste and abuse. Q: What can members do to curb fraud? A: Members can help curb fraud in the following way: - Members should not give their membership card to anyone except healthcare service providers who are rendering services to them. - Members should avoid giving their membership numbers to third parties over the telephone. - Members should never physically sign claim forms if they have not seen the service provider. - Members should not accept money or gifts from service providers in exchange for medical benefits. Further, members should check their monthly Remittance Advice (statement) and ensure all payments made on their behalf relate to services actually rendered. Any anomalies indicating known or suspected fraud should be reported to the independently administered Tip Offs Anonymous. Toll free Tip Offs Anonymous Hotlines: TelOne: 0800 4100 /1/ 3-6; Econet: 0808 5500, 4461; Netone: 0716 800 189/190; Telecel: 0732 220 220, 0732 330 330; Fax: 0800 4146 E-mail: reportszw@tip-offs.com; Website: www.tip-offs.com ISSUE NO. 19 JULY 2018 5
Engage Question of the Month? What happens if one does not pay contributions on time? Stand a chance to win exciting prizes that include cooler bags, T-shirts and Cimas branded notebooks simply by sending your answer to connect@cimas.co.zw. ISSUE NO. 19 JULY 2018 6
ISSUE NO. 19 JULY 2018