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Healthcare Financing (Lesson 7 (Documentation and in flight management)…
Healthcare Financing
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Lesson 8 (Charging)
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Closing the bill
Closure of bill refers to instruction issued to the billing system to stop accepting series entries / charge code entries for an account
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Lesson 9 (Billing)
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Free cap inpatient
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subsidized patients would not be put to excessive difficulty in meeting the revised hospital charges due to unnecessary tests / investigations
Applied to: Surgical operations, laboratory tests and specialized investigations, X-rays, rehabilitative services and standard medications
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Receipt portion of bill
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It is important to display the information in one document for the purposes of medical employment benefits and insurance claim
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When information is inaccurate, billing errors will occur.
Payment VS Deposit
Payment - Treated as money paid for services rendered.
Deposit - deemed to be monies that may be refunded.
Name a model that is possibly better than Patient Centric Collection and Ward Centric Collection. Explain.
ANSWER: HYBRID MODEL
It promotes economies of scale, geared for seasonal variations and shared goals, standardization and dissemination of best practices.
Direct entry VS Batch interface
Direct entry - into billing system by billing staff (use of charge forms)
Batch / online - interface of services from ancillary medical system to billing system (entry of service items by the various service stations)
What are the disadvantages of manual entry of services (using charge forms)
Human dependent and prone to error, subject to availability of staff to perform the work as opposed to automated entry by system.
Charge entry VS Order entry
Charge entry - a service that has been performed and is pending data entry
Order entry - a service that has not been performed and is pending data entry
Why does CDM often reveal breakdowns?
- Inaccurate charge descriptions for services or supplies in CDM
- Inconsistent pricing across department for similar serices
- Obsolete charges are in CDM
- Miscellaneous charge codes
Administration of the charge capture process (Negative)
- Clinical staff is not capturing all appropriate charges
- System limitation
- Inadequate monitoring of daily department revenues
- Ineffective and insufficient charge capture tools
Employment of technology to the daily charging practice
- Improvement in overall charge capture, clinical documentation, and reduction in back-end claim manipulation
- Real time feedback to clinical staff allow generation of a clean compliant and comprehensive claim
- Ultimately, increase cash flow and generate increased bottom-line revenue
Final bill - original / duplicate
The original bill will be printed and given to patient.
Bill stamped with "certified true copy" and acknowledge by the staff will be treated as original copy.
Billing category VS Bill summary code
Billing category: a categorization code used to group service code in a pricing catalogue.
Bill summary code: used for a purpose of presentation on a summary bill.
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Downtime bill
An option is to permit patients to depart from the clinic without billing patient.
Only for outpatient setting and collection in advance and deposits.
Payment modes involved for a hospital's over the counter collections?
- Cash
- NETS
- Cash cards
- Credit cards
- Cheque
- EZ-link care
Prior to printing the close counter report, the system requires the cashier to enter the amount collected. Why?
- To prevent fraud
- The total amount from counting should reconcile with the total of the transacted amount captured in the system