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Healthcare financing (Lesson 11 Claim processing (Billing stages: Unbilled…
Healthcare financing
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Lesson 12 off-site payment, refunds and outstanding payment
various payment mode: cash, credit card, cheque, nets
Other payment mode: AXS, SAM, Singpost payment, Cheers, Online and internet payment
Payment issue such as reconciliation issue, delay in reflecting correct payment status.
Refund: Must have credit balance in the AR in order for refund to be made
Partial refund: Refund may not be full amount, can be partial
Refund process: Supporting documents such as refund voucher,medication refund now from pharmacy and approval from supervisors and finance department .
Issues: limited mode of refund, monitoring is required and potential fraud
Bank reconciliation: Business office assistant will prepare the bank reconciliation monthly to be reviewed by supervisor. A copy the bank reconciliation will be forwarded to the finance department for their retention.
Outsourcing, Can outsource to another party.
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Counter Collection [L10]
Shortages
- When shortage recorded, it has to be topped up on the same day and banked in together with the current day's collection
- Any topping up of cash shortages for amounts highlighted by Business Office should be separated from the current day's collection.
- The cash top-up must be handed over to Business Office staff for bank-in
- For shortages exceeding a high amount (E.g.$100), the cashier may request to pay by installment, Manager incharge should seek approval from the Business Office Manager of Executive
Excess
- Any excess cash collection should be banked-in together with the current's day collection
- Cashier should indicate on the Counter Discrepancies Form the excess collection amount and an explanation resulting in the excess collection
Credit card Collection
- For credit card transactions, Cashier is required to print the Detailed and Batch Settlement Reports from the credit card terminals.
- Supervisor has to ensure that the sales slips are duly signed by the cardholder and are collated according to the Detailed Report.
- Total count and amount of approved sales slips must tally to both Detailed and Bath Settlement Report
- Void sales slips must be submitted to Business Office.
- In the event of missing credit card slips, supervisor must identify the patient's bill details and make an indication on the Close Counter Statement
Payment method
- cash
- NETS
- Cash card
- Credit cards
- Cheque
- Ez-link Card
NETS Collections
- NETS transactions, cashier is required to print the Batch Settlement Report from the NETS terminals
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Charging of bill [L8]
Essential information
- Patient information
- Item description
- Quantity
- Service code
- Acknowledgement of data entry completion
Charge capture process2 ApproachesCentralize revenue management:
- Data entry are sited in an area away from where services are performed.
- Single staff is responsible for the data entry work [Charge analyst
Decentralized Revenue Management
- Data entry are sited in the wards or where services are performed
- A team of staffs are responsible [PSA/PCA]
Advantages & Disadvantages of the 2 approaches
Centralized Revenue Management Approach
Advantage:
Sense of accountability for appropriate charging from charge analyst
Disadvantage: Possibility of higher course
Decentralized Revenue Management
Advantages: Manpower is lower through multitasking of staff
Disadvantage: Daily charge reconciliation is often delayed/not performed due to lazy of understanding revenue aspect
Batch interfaces
2 interfaces
- Direct
- Batch/Online
Benefits of Batch interface:
- Shift the time of job processing to when the computing resources are less busy
- Avoids idling the computing resources with minute-by minute manual intervention and supervision
- High overall utilization [amortize the IT system]
- allows interative work
-Effective use of manpower
Benefits of direct interface
- Do not have to worry if IT system break down
Billing [L9]
Fee Cap Inpatient
- For Class B2 and C patients
- Purpose: subsidised patients would not be put to excessive difficulty in meeting the revised hospital charges due to unnecessary test/investigations
- Applied on surgical operations, laboratory tests and specialised investigations, X-rays
Subsidy Cap for Implant
- For implants and prostheses
- Class B2/C patients given 50% subsidy
- Maximum subsidy of $500 as long as the consultant-in-charge certifies that there is no other cheaper alternative
- Purpose: Subsidized patients as previously they would need pay full cost for non-standard implants and prostheses
Type of bill
Interim bill
- Bill/invoice is open to addition of new charges
Provisional Bill
- Bill/invoice is closed to addition of new charges but is not yet ready for generation
- Bill/invoice is submitted via CCPS/Central Claim Processing System for claiming against Medisave, Medishield and Private Medical Insurance
Final Bill
- Services rendered has been keyed in the system
- Bill returns from CPF board and is ready for generation
- Once bill finalised, original bill will be printed
- Extra copies will be duplicate copies
- Bill stamped with "certified true copy" and acknowledge by staff
Cancelled bill
- Bill/invoice is re-opened for addition of new charges
Re-bill
- New bill to the patient as there are changes to the charges in the bill
A&E bill
- Subsidies are accorded to all emergency patients regardless of their citizenship and/or residential status of patient
- Subsidy rate is set at 50% of the norm cost of treating emergency case
- Other 50% are to be recovered by patient