SMC tells doctors they must be satisfied with rationale for TPA fees

The Singapore Medical Council's latest Ethical Code and Ethical Guidelines stipulate that doctors have to stop paying  third-party administrators fees that are linked to their bills.
The Singapore Medical Council's latest Ethical Code and Ethical Guidelines stipulate that doctors have to stop paying third-party administrators fees that are linked to their bills. PHOTO: ST FILE

Singapore - Doctors who provide services to third-party administrators (TPAs) would not be in breach of the revised ethical guideline if they are satisfied that the fees charged reflect the amount of work done.

It would be acceptable if the TPAs are able to provide the rationale behind the different fees, said the Singapore Medical Council (SMC) in a comment to doctors on Friday (June 30) in a bid to allay their fears of going against guidelines when it comes into force on July 1.

However, if two similar cases are charged different rates by the TPA, it might breach the guideline because the fees will then appear to be based on the doctor's fee, rather than the complexity of work carried out by the agent, explained the council.

The SMC's latest Ethical Code and Ethical Guidelines stipulate that doctors have to stop paying TPAs fees that are linked to their bills, a practice known as fee splitting.

Just one week ago, the regulatory body issued an advisory saying that a number of new TPA fee structures did not make the mark, sparking worry among doctors - some of whom have called the council about the matter.

The SMC said on Friday (June 30) that it is aware that some TPAs have amended their fee structures further in the past week to try to meet the new requirements.

It told doctors that it is acceptable if the TPAs are able to give the rationale behind different fees it collects, for example "higher administrative fees where the claims involve greater complexity of work". As to the amount of fees collected, which could amount to a four-figure sum, the SMC said that "this is a function of market forces and business costs, and each doctor must assess the reasonableness of the quantum of these fees".

It cautioned that payment to TPAs "must not compromise the proper care of his or her patients".

TPAs generally represent insurers or employers who provide fully paid for or subsidised medical care to their clients or employees.

They negotiate rates with doctors to try to keep a lid on healthcare costs for their clients, and collect a fee from doctors for this service.

Historically, these fees were a straight percentage of the bill. But the SMC had deemed this as fee splitting, which is against the professional ethics for doctors. The SMC said such fee splitting could also raise healthcare costs.