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S353 - Financing for Health care -Patient revenue cycle (Lesson 8: Charge…

- - - - Data obtained during Registration
        
        Document type (From data in identification documents, e.g NRIC, Work permit)
        
        Case type (e.g Outpatient)
        
        Visit type (e.g First visit, follow-up visit)
        
        Referral source (e.g Polyclinic, GPs, Self-referral)
        
        Payment class (e.g Singapore Citizen, Permanent Resident, Foreign Resident, Non-resident)
        
        Attending service provider
        
        Determining Patient Class
        
        Public hospital:
        Patient classes: SG, PR, Foreign Resident, Non-resident
        Documents required:
        
        Identification documents e.g. NRIC, Work permit, Employment Pass, Passport
        
        Referral documents e.g from polyclinics, other hospitals, A&E, SOC
        
        Public Specialist Outpatient Clinics (SOCs)
        Patient classes: SG, PR, Foreign residents, Non-resident
        Documents required:
        
        Identification documents e.g NRIC, work permit, Employment Pass, Passport
        
        Referral documents e.g from polyclinics, hospitals, A&E, CHAS GP, Non-CHAS GP
        
        A&E Department in public hospitals - > Patient classes: SG, PR, Foreign, Non-resident
        Documents required:
        
        Identification documents e.g NRIC, Work permit, Employment Pass, Passport
        
        Referral documents e.g from polyclinics, other hospitals' A&E, CHAS GP, Non-CHAS GP
        
        Polyclinic -
        Patient classes: SG, PR, Foreign, Non-resident
        Adult, Elderly or Children
        Documents required: Identification documents e.g NRIC, Work permit, Employment Pass, Passport
      - When it is inaccurate... billing errors will occur
  - - - Validation:
        
        May not be a valid Civil service card (E.g no entitlement)
        
        Patient may no longer by employed under
        
        Civil service card may no longer be valid
  - - - PSA or ward clerks are tasked with monitoring the debt of patients
        Advantage: Staffs are located in the wards and is able to detect visitors of patients
        Disadvantages: Staffs have to multi-task, the work and information involved in financial management is intensive
    - - Is located in a central location away from patient. They have access to patient financial and review the debt situation remotely.
        Advantages are staff are centrally located and smaller team is required. Intensive training & information is readily offered.
        Disadvantage is staff must proceed to the wards to liaise with patients and family members.
- - - - Robust
      - Flexible
      - Accurate
      - Timely
      - Complete
      - Comprehensive
    - - A charge form is a document used by nurses to record the services rendered for a patient
        
        Elements of a Charge form
        
        Patient Information
        
        Item description
        
        Quantity
        4.Service Code
        
        Acknowledgement of data entry completion
    - - Data entry of services will be performed by billing staff reading from the charge form
    - - Services entered into the bill must be reconciled with the charge form
  - - - Data entry clerks are sited in an area away from where the services are performed
        A single staff is responsible for the data entry e.g a Charge Analyst
        
        Advantage: Sense of accountability for appropriate charging from Charge analyst
        
        Disadvantage: Possibility of higher cost due to Charge analyst (resource)
    - - Data entry clerks are sited in the wards or where services are performed
        A team of staff is responsible e.g Doctors, PSA/PCA, Nurses
        
        Advantage: Manpower need is lower through multitasking of staffing
        
        Disadvantage: Daily charge reconciliation is often delayed or not performed at all as clinical staff may not understand the revenue aspect of patient care/secondary responsibility as care giver
  - - - Disadvantages: Human dependent and prone to error, subject to availability of staff to perform the work as opposed to automated entry by system
    - - Usually used to collect transactions over a period of time and then process all of the transactions at once
        
        Benefits:
        Can 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
        By keeping high overall rate of utilization, it amortizes the IT system
        Allows system to use different priorities for batch and interactive work
        Allows effective use of manpower [key entries only one]
        
        Key concerns:
        Quantity cannot be zero
        Services must be performed within Length of Stay
        Zero priced items are allowed
        In the event, service codes are not available. Miscellaneous codes
  - - - A service has been performed and is pending data entry
    - - A service has NOT been performed and is pending data entry
  - - - If a service is entered in this stage, it will be termed as a late charge
  - - - Defined by a list of items & quantity
    - - Defined by a price tag to treat a specific medical conditions. Usually further defined by list of exclusion
- - - - Hospital bill includes:
        Patient info.
        Description of service rendered
        Amount of the service
        Total payable amount by 3rd party (if any)
        Total payable amount by patient
      - Types of bill
        
        Provisional bill
        
        Final bill
        
        An original bill will be printed and given to patient
        
        If patient request for extra copies, it will be duplicate copies
        
        Cancelled bill and Re-bill
        
        Cancelled bill stage refers to the period when bill or invoice is re-open for addition of new charges (or late charges)
        
        If patient has received a copy of first bill, they must be advised of the re-bill via verbal or written means,
        
        The rebilled will be considered as a new bill to the patient as there are changes to the charges in the bill. An original invoice will be given for rebilling.
        
        Unbilled stage/Interim bill
  - - - 2 Approaches to Fee cap
        
        Modern Approach or One major fee cap/ 3 in 1
        
        Traditional method or 3 Individual Fee caps
      - Pharmacy
      - Subsidy cap for implant
  - - - GST is absorbed by government healthcare institutions
- - - - To ensure reconciliation and timely detection of discrepancies, cashier or collection staff must ensure that Close Counter is performed after the day's shift and the total collections received reconcile to the amounts in the Close Counter Statements
        
        Shortages
        
        Fraud or negligence could be detected with counter collection mode
        A shortage happens when actual collection in terms of cash and other modes is less than the amount stated in the system
        Where a shortage is recorded, the shortage is 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 current day's collection
        The cash top-up must be handed over to Business Office staff for bank-in
        For material shortages exceeding a high amount, Cashier/Collection staff may request to pay by installment, Manager-in-charge should seek approval from the Business Office Manager or Executive
        
        Excess
        
        Any excess cash collection should be banked-in together with the current day's collection.
        Cashier/collection staff should indicate on the Counter Discrepancies Form the excess collection amount and an explanation resulting in excess colection
        
        Refund
        
        Front-end
        
        Cashier or collection staff may process an upfront cash refund if the customer requires refund immediately
        A correct invoice and SAP refund form is to be printed out for patient to acknowledge the cash refund by signing on the SAP refund form
        SAP refund document is to be enclosed with the daily Close counter statement and send to Clinic or Location Manager for verification and submission to the Business Office
        
        Back-end
        
        When Customer has left the vicinity, the refund is initiated through the Refund Request form (Excess)
        Supervisor/Executive/Manager in charge at the respective department must complete and sign the form before submitting to Business Office
  - - - Cashier or collection staff is required to print the Detailed and Batch Settlement Reports from the credit card terminals.
        Supervisor or Leader has to ensure that sales slips are duly signed by cardholder and are collated according to Detailed report
        
        The Total count and amount of approved sales slips must tally to both the Detailed and Batch Settlement report
        Void sales slips must be submitted to Business office.
        In the event of missing credit card slips, supervisor or leader must identify the patient's bill details and make an indication on the Close counter statement
    - - Cashier or collection staff is required to print Batch Settlement Report from NETS terminals
        Supervisor/Leader has to ensure that the NETS slips are collated according to the Batch Settlement Report
        Total count and amount of NETS slips must tally with the Batch settlement Report. Void NETS slips must be submitted to Business Office
        Missing NETS slips: Supervisor/leader must identify the patient's bill details and make an indication on the close counter statement
- - - - From patient directly
    - - Patients pay their medical bills through other agencies other than by themselves.
        
        Private organization/employers/Insurance companies of the patients (Letter of Guarantee - Manual claim)
        
        CPF - CCPS
        
        Mediclaim system - Medisave, Medishield Life, Integrated Shield plan
        
        Civil service
        
        MCPS and Medical Billing System (MBS @ Gov)
  - - - Denied claim (has been processed; can be appealed)
      - Rejected claim (has not been processed; cannot be appealed)
        
        Insufficient information sent
        Wrong information sent
        Non claimable item sent
        Missing out on charging certain items
        Bill exceeded claimable amount
        Not all bills submitted for claim will be approved
        
        Reasons for rejection
        
        Patients no longer eligible for 3rd party claims
        Plan does not cover the service used
        Insufficient amount in account
        Wrong date of birth entered
        Wrong 3rd party payer e.g selected MCPS instead of CCPS