By Gerhardus (Gert) Viljoen | CEO, V Professional Services Medical Bureau | Healthcare Finance Specialist | Medical Bureau & Practice Management Advisory
I have spent the better part of two decades at the intersection of healthcare and corporate finance in South Africa. I have served on boards of healthcare entities across multiple provinces, navigated the OHSC compliance framework at executive level, and built financial management systems for medical practices ranging from single-specialist consulting rooms to multi-disciplinary ambulatory care centres.
In that time, the single most consistent finding is this: the average South African medical specialist is an exceptional clinician and a poorly supported business owner. Not because of a lack of intelligence or ambition, but because the financial, administrative, and regulatory infrastructure that most practices operate on is simply not built to protect their income, their time, or the long-term value of what they have built.
This article is about that gap and about what genuine, specialist-level healthcare finance support actually looks like when it is done properly.
The Revenue Leakage Problem No One Talks About Honestly
Medical bureau services in South Africa exist, in theory, to ensure that specialists are correctly and timeously reimbursed for the clinical work they perform. In practice, the gap between what a specialist should be collecting and what most practices actually collect is significant – and largely invisible to the practice owner.
The reasons are structural and well-documented within the industry:
Tariff code errors and under-coding: Incorrect application of NHRPL tariff codes – whether through outdated fee schedules, inappropriate modifier usage, or failure to claim all procedural components results in systematic under-billing that compounds quietly over months and years. A specialist performing 15 procedures per week with a 5% under-coding rate loses material revenue annually that is never recovered.
Claim rejection management: The Board of Healthcare Funders and individual medical schemes operate with increasing administrative rigor. Rejected claims that are not followed up within the scheme’s stipulated timeframe – typically 90 to 180 days are written off. In most practices, rejection follow-up is handled by administrative staff who are not trained in scheme-specific appeal and motivation processes, ICD-10 coding requirements, or the clinical justification documentation that successful appeals require.
PMB billing failures: Prescribed Minimum Benefits create a statutory obligation on medical schemes to fund defined conditions and procedures in full. Many specialists are not billing PMB claims correctly, which means they are accepting scheme tariffs on procedures that should be reimbursed at cost. The Medical Schemes Act 131 of 1998 and the PMB definition benefits are explicit on this point. Correct PMB identification and billing is not optional, it is a right that most practices are not exercising.
Cash flow mismanagement: The average debtor collection cycle for South African specialist practices runs between 45 and 90 days from date of service to receipt of payment. Practices that do not actively manage this cycle with structured debtor age analysis, proactive patient liability follow-up, and medical aid pre-authorisation discipline, carry unnecessary working capital pressure that constrains their ability to invest in their practices and their own financial planning.
The aggregate impact: A specialist practice collecting 90 cents in every rand owed, which is better than average for practices without active bureau management is effectively writing off 15-25% of clinical output annually. Over a ten-year career, that number is not a rounding error. It is a material portion of the financial legacy a specialist builds from their clinical work.
What the NHI Transition Means for Specialist Revenue Models
The National Health Insurance Act 20 of 2023 introduces structural change to the South African healthcare reimbursement landscape that every specialist needs to understand – not in abstract policy terms, but in the specific context of how their practice will be reimbursed in a transitioning system.
The accreditation framework administered by the Office of Health Standards Compliance (OHSC) will determine which providers participate in the NHI Fund’s contracting processes. Accreditation is not purely clinical, it encompasses governance, financial management, billing integrity, and administrative infrastructure. Specialists and practice owners who have not invested in the financial and governance infrastructure of their practices will find themselves at a material disadvantage in the accreditation process, regardless of clinical excellence.
Simultaneously, the complementary private medical scheme market, which will continue to serve patients who retain means and preference for private access is contracting its provider panels and tightening scheme rules. Specialists who cannot demonstrate billing compliance, clean claims histories, and professional practice administration are increasingly finding themselves de-panelled or facing benefit reduction disputes that erode their effective tariff rates.
The practices that will be best positioned in the NHI transition, whether they participate in the public contracting tier, the complementary private tier, or both – are the ones whose financial and administrative infrastructure is already operating at a professional level. The time to build that infrastructure is not when the system changes. It is now.
What V Professional Services Actually Does – in Plain Terms
V Professional Services is a healthcare finance and medical bureau advisory firm. We work with medical specialists, group practices, and healthcare facility owners across South Africa to close the revenue leakage gap, professionalise practice financial management, and build the administrative infrastructure that protects clinical income and practice value.
Our work spans four practice-facing disciplines:
Medical bureau and billing management: We manage the full billing cycle for specialist practices, from tariff code review and claim submission to rejection management, PMB identification, and patient liability follow-up. We work with all major medical schemes and their administered entities, and our billing processes are aligned with ICD-10 coding standards and current NHRPL tariff structures. For most practices we engage, the first measurable outcome is an improvement in gross collection rate within the first billing cycle.
Practice financial governance: Beyond billing, we bring corporate finance discipline to medical practice management – monthly management accounts, debtor age analysis, cash flow forecasting, and expense structure review. Most specialist practices do not have visibility into their true financial position on a monthly basis. We build that visibility and use it to make the practice financially predictable for the specialist rather than perpetually surprising.
Regulatory compliance and NHI positioning: We advise practices on OHSC compliance requirements, medical scheme rule navigation, Health Professions Council of South Africa (HPCSA) practice obligations, and NHI accreditation preparation. The regulatory environment for South African healthcare providers is complex and actively changing. We provide specialists with a structured understanding of their compliance position and a practical remediation plan where gaps exist.
Corporate structure and governance advisory: For specialists who hold interests in practice entities, procedure rooms, or healthcare facilities, or who are considering doing so – we provide corporate governance and finance advisory services aligned with the Companies Act 71 of 2008 and King IV principles for unlisted entities. This includes shareholder agreement review, buy-sell arrangement structuring, practice valuation, and board governance for group practice structures.
Who we work with: We work with specialists across disciplines – surgeons, physicians, gynaecologists, oncologists, orthopaedic specialists, radiologists, and anaesthesiologists – as well as GP networks, day clinic operators, and allied health professionals managing practices of sufficient scale. Our engagement model is structured around the specific needs and complexity of each practice, with fee arrangements that reflect the value we deliver rather than a standard overhead charge.
The Conversation Most Practice Owners Are Not Having With Their Advisors
The typical specialist receives financial advice from an accountant who prepares annual financial statements and manages tax compliance, and practice administration advice from a billing clerk or practice manager who handles day-to-day operations. Neither of these relationships is designed to optimise the practice as a business – the accountant works retrospectively, and the administrator works operationally.
The question that almost never gets asked by either advisor is: what is this practice worth, what should it be worth, and what would it take to close that gap?
A specialist in a well-managed, well-governed practice with clean billing records, a strong collection rate, professional debtor management, and compliant OHSC and scheme credentials is sitting on an asset with genuine market value to a group practice seeking expansion, to a hospital group building an ambulatory strategy, to a private investor acquiring healthcare assets. Most specialists have no visibility into this value, and therefore no ability to plan for it or protect it.
We bring that visibility. And for specialists who are at a stage where they are considering the future of their practice – whether that means scaling, partnering, or eventually exiting – understanding the true financial value of what they have built is the starting point for every meaningful conversation that follows.
Our Interest in Acquiring Medical Centres and Healthcare Businesses
I want to be transparent about something beyond our bureau and advisory services.
V Professional Services is actively evaluating opportunities to acquire medical centres, specialist practices, and healthcare businesses in South Africa. This is not a passive interest – it is a structured acquisition programme, informed by our understanding of the healthcare regulatory landscape, our experience in medical practice finance, and our ability to apply professional governance and management capability to businesses that are operationally sound but require a more sophisticated ownership structure to reach their potential.
The practice owners we are most interested in speaking with are those who have built something of genuine clinical and operational quality, and who are either approaching a natural transition point (retirement, partnership dissolution, redeployment of capital) or who recognise that their practice would benefit from the resources, governance infrastructure, and corporate finance capability that a professional ownership structure provides.
These conversations are confidential, specific, and professional. They begin with a genuine assessment of the practice’s financial and operational position – the same assessment we bring to every advisory engagement. And they proceed only where there is a genuine alignment of interest between the seller’s objectives and our acquisition criteria.
If you are a practice owner in that position, or if you know someone who is, I am available for a direct and confidential conversation.
To medical specialists considering a bureau or advisory relationship: The first conversation costs you nothing and commits you to nothing. It is a direct assessment of whether your current practice is collecting what it should be, governed as it should be, and valued as it should be. In my experience, that conversation is almost always useful and frequently surprising. Reach out directly: gert@vprof.co.za
Gerhardus (Gert) Viljoen is CEO of V Professional Services, a healthcare finance and medical bureau advisory firm serving specialist medical practices across South Africa. He is a corporate governance specialist, and a member of the Institute of Directors South Africa and the South African Institute of Professional Accountants. He holds B Compt (Hons) CTA and CPA qualifications.
V Professional Services | gert@vprof.co.za | Gauteng | Serving specialist practices nationally.
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