What changes when a practice runs on MedFi

What was broken

Remittances arrived from four different medical aids every month in four different formats. One person matched lines in Excel over two days, and never finished. Shortfalls were not queried because there was no time. The practice did not know how much it was owed.

What changed

Remittances are uploaded once; every line is matched automatically against the claims ledger. Short-paid and rejected lines are isolated, and query letters are drafted from the matched data. Bank confirmation closes the loop only when the money actually arrives.

What is now possible

Reconciliation that used to take two unfinished days is a review task. Shortfalls are visible and actioned, not written off. The practice knows its true outstanding position at any time.

What was broken

Claims were submitted with tariff codes copied from an old schedule. Several aids paid at the wrong rate or rejected for missing clinical justification. The practice only found out weeks later, when the remittance arrived.

What changed

Claims are scrubbed before submission against current tariffs and payer rules. Missing justification, expired pre-authorisations and wrong member numbers are flagged at the desk, not at the payer. A clean batch goes out; rejections come back fewer and explainable.

What is now possible

More claims pass first time. The ones that do come back rejected have a reason code and a clear path to correction, instead of a guessing game.

What was broken

Patient files were on a shared laptop with one login. Consent was captured verbally, not recorded. There was no written access list and no breach plan. The practice could not say who had accessed a given record.

What changed

Access is role-based and audited. Consent is captured at intake and stored against the patient. A written processing register, access list and breach-response plan are maintained in the system. The in-house DPO (a practising lawyer) reviewed the setup against S.I. 155.

What is now possible

The practice can produce what an inspector asks for — licence, DPO notice, access list, consent records, audit trail — from the same system that runs the practice.

What was broken

Each branch tracked its own payments in its own spreadsheet. The owner could not tell which invoices had actually been paid versus which had been short-paid. Bank deposits were matched to invoices by hand.

What changed

Remittances and bank deposits are reconciled against invoices in one ledger. No invoice is closed until the bank confirmation gate passes. Shortfalls surface per branch, per payer, per claim.

What is now possible

The owner sees one reconciled position across all branches. Write-offs are a conscious decision, not an accident of incomplete matching.