Please enable JavaScript.
Coggle requires JavaScript to display documents.
HEALTHCARE FINANCING (LESSON 06 FINANCIAL COUNSELLING (Means Testing (Mix…
HEALTHCARE FINANCING
LESSON 06
FINANCIAL COUNSELLING
Enabling patients to have choice
of class, primarily Private or Subsidized
To seek alternative options at other institutions
Let them decide to proceed or not to proceed
Standard or non-standard options
Estimated bill size information for inpatient/day surgery treatment because of the large bills
Saving patients & families from financial burden
General Rules &
Regulations
Upgrading
If patient request for upgrading to
to a higher ward class, all charges incurred
(except patient daily standard ward fee) at
the lower ward class up till the upgrading will
be recomputed & charged at the higher class rate
Downgrading
Patients can be downgraded from private to
subsidized ward class if they pass the downgrading
procedure (means testing)
Downgrading/
Upgrading
Subjected to availability of beds &
takes effect when the patent physically
occupies the lower/higher class bed
SOC after discharge
(Follow-up)
Class A/B1 patients will be charged at private rate
Class B2C patients will be charged at subsidized rate
(only for SG & PRs)
Other citizenship will be charged at private rate
Patients under Industrial Accident would be
charged at private rate
Means Testing
Because of the trend in 2002 of
higher income people opting for
highly subsidized C-class & B-class wards
To prevent the undeserving "rich" from abusing subsidies
Differentiating eligibility
for diff levels of subsidy result in a
"middle class squeeze"?
Middle-income group expected to be worst hit by means testing
Those with chronic conditions that require
long-term care might not be able to cope
with financial burden should the existing subsidies be lowered
Mix & Match activity
Individual Means Testing
Inpatient admission
For EMPLOYED, based on average monthly icome received last available 1 year period ( bonuses but not the last salary are included for calculation)
Voluntary contributions to CPF will not affect the income information
For SELF-EMPLOYED
Based on the monthly income derived from last available net trade assessed by Inland Revenue Authority of Singapore within last 2 assessment years/the income declared to CPF board wuhin last 2 years
For UNEMPLOYED/NO INCOME
Receive full subsidy (65% for Class B & 80% for Class C wards)
BUT
If they live in a property within an annual value of more than $11,000,
they are given subsidies of 50% & 65% respectively for Class B2 & C wards)
Household Means Testing
Inpatient downgrading
ILTC subsidy
Medifund application
CHAS apllication
Gross income of person needing care, his/her spouse & all immediate family members living in the same household
& total no. of family members living in the same household
or annual value of place of residence for households with no income
LESSON 07
DOCUMENTATION &
INFLIGHT MANAGEMENT
Information when registering
patient in a public SOC?
Patient details include:
Patient unique
identification number
Name
DOB
Address
Other necessary info:
Contact number
3rd party payers
NOK info
Allergy info
Referral sources
When info is inaccurate,
billing errors will occur
Data obtained
during registration
Document type (data from
identification documents like NRIC, Work Pemit)
Case type (Outpatient etc)
Visit type (First visit, follow-up visit etc)
Referral source (e.g Polyclnic,
GP, Self-referral)
Payment Class (e.g SG citizen, PR, Foreign Resident, Non-resident)
Attending service provider
Determining Patient
Class & documents
required
1) Polyclinics
SG citizen, PR, Foreign Resident, Non-resident
Adult, Elderly, children
Documents required are identification documents
NRIC, Work Permit, Employment Pass, Passport
2) AED in public hospitals
SG citizen, PR, Foreign, Non
Identification documents like NRIC etc
Referral doc (from poly, other hospitals A&E, CHAS GP, Non-CHAS GP)
3) Public SOCs
SG citizen, PR, Foreign & Non
Identifications (NRIC, Work permit, Employment Pass, Passport)
Referral documents (from poly, hospitals, A&E, CHAS GP, Non-CHAS GP
4) Public hospitals
Same
Same
Same + SOC.
MCPS (Medical Claims Proration System
Medical benefits & claims processing that helps Singapore Civil Service to centrally manage & process emplyee healthcare benefits
Integrated with healthcare providers, insurance companies & various government agencies, streamlined medical claims processes & enabling public service employees to enjoy medical benefits at clinics & hospitals
May not be a valid Civil Service Card (e.g No entitlement)
Patient may no longer be employed under civil service
Civil service Card may no longer be valid
LESSON 08
CHARGING CAPTURE PROCESS
THE REVENUE CYCLE
PATIENT ACCESS
(FRONT END)
Scheduling & Pre-registration
Financial clearance
Financial counselling
Arrival & Registration
Denial Prevention
CHARGE INTERGRITY
(Middle)
Pricng
Charge Capture & Methodology
Health Information Mangaement & Clinical Documentation
Coding
Third Part Reimbursement
PATIENT FINANCIAL SERVICES
(Back End)
Managed Care Contracting
claims Processing
Account Resolution
Denial Resolution
Payment Posting
CHARGE FORM
To record the services rendered for a patient
Data entry of services will then be performed by billing
staff reading from the charge form
Services entered into bill
must be reconciled with the charge form
Requirements:
Patient Information
Item description
Quantity
Service code
Acknowledgement of data entry completion