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Patient Revenue Cycle (P07 Documentation and Inflight Management (Inflight…

- - - - Essential elements of a charge form
        
        Patient information
        
        Item Description
        
        Quantity
        
        Service Code
        
        Acknowledgement of data entry completion
      - Managing charge capture process (2methods)
        
        Centralized Revenue 'Management'
        -Decentralized Revenue ''
      - Service Code (2 Modes)
        1.Direct Entry of services into billing system by billing staff (use of charge forms).
        2.Batch / Online interface of services from ancillary medical system to billing system. (entry of service items by the various service stations)
        
        Batch Interface : Usually use to collect transactions over a period of time & then process all of the transactions at once.
        Benefits : - It can shift the time of job processing to when the computing resources are less busy.
        
        It 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.
        
        It allows the system to use different priorities for batch and interactive work.
        
        It allows effective use of manpower, key entries only once
        
        Online Data Entry (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 may be used.
        
        Charge entry : is a service that has been performed and is pending data entry.
        Order Entry: is a service that has not been performed and is pending data entry.
        
        Closing the bill : Instruction issued to the billing system to stop accepting service entries / charge code entries for an account. A service entered after a bill closed , it is considered as late charge.
        
        Late Charge : For hospital billing, the bill has to be opened / cancelled if it has already been closed / billed, before any late charge can be entered.
        
        Packages 1. Item based package : A package defined by a list of items and quantity. (Similar to Macdonald set meal)
- - - - Credit Assessment & Follow Up
        
        According to the various rating (E.g. A, B,C) They are categorize based on different status, payer and follow up actions
        -
        
        Ward Centric Collection
        
        PSA or ward clerks are tasked with monitoring the debt of patients.
        
        The advantage is staff are located in the wards and is able to detect visitors of patients.
        
        The disadvantage is staff has to multi task, the work and information involved in financial management is intensive.
        
        Patient Centric Collection
        
        A team of PSA is located in a central location away from patient. They have access to patient financial data and review the debt situation remotely.
        
        The advantages are staff are centrally located and smaller team is required. Intensive training and information is readily offered.
        
        The disadvantage is staff must proceed to the wards to liaise with patients and family members
        
        Hybrid model ( Prefered choice to be compared to Ward / Patient Centric Collection)
        
        Promotes economic of scale
        
        Geared for seasonal variation & shared goal
        
        Standardization & dissemination of best practices
        
        Specific Bad debt provision - Patients with 'F' credit ratings must be submitted to finance for bad debt provision. The bad debt amount must be communicated to the Finance Dept.
        
        Techniques for collection in the ward
        
        Placing documents in the ward
        
        Bill Escalation Warning
        -An interim bill is given for the following reason:
        
        To collect any cash outstanding before patient leaves the hospital.
        -To ensure patient is aware of his medical bill upon discharge as a final copy will not be presented immediately due to CCPS processing.
        
        Discharge Summary Form (SNEC)
        
        Purpose: Upon discharge, the summary provides details of the patient medical condition. It is given to patient in the event that the employer or insurer needs the medical information for processing of medical bills.
- - - - A&E/emergency dept bill:
        -a single flat fee system applying to both emergency & non-emergency patients
        -cost of treating an emergency case is far higher than that of a non-emergency case
        -since the amount to pay is much higher, a patient with a minor ailment should be deterred from clogging up A&E department
  - - - Meant to help subsidized patients as previously they would need to pay full cost for non-standard implants
  - - - Original/duplicate:
        
        Once bill is finalised, an original bill will be printed & given to patient
        
        In the event that patient request for extra copies of the bill, it will be duplicate copies
        
        Bill stamped with "Certified true copy" & acknowledge by the staff will be treated as original copy
    - - Billing category VS Summary code
        
        Billing category: a categorization code used to group service code in a pricing catalogue
        
        Bill summary code: a code that is used for purpose of presentation on a Summary Bill.
        
        Service code:
        a unique code that describes the services or item with a price
        Bill cum receipt (invoice):
        
        Displays the services consumed & the payment details
- - - - What happens when a shortage occurs?
        -Topped up on the exact day
        
        Highlighted by Business Office (separated from current's day collection)
        
        If the shortage is more then $100, cash can request to pay to buy installment and at the same time, manager-in-charge have to seek approval from the business office manager or executive.
        
        What happens when there is excess?
        
        Cashier staff will indicate on the counter discrepancies form the excess amount and explanation for the amount.
        
        Most cases, they will return $$ back to the patient
        
        Before closing counter, cashier needs ro enter total amount from his counting of her collection in order to prevent fraud
        
        Cards
        
        Nets Collection - Staff required to print batch settlement report from NETS terminals
        
        Supervisor/ Leaders has to ensure the slips are according to Batch Settlement Report
        
        Total amount of NETS slips must tally with Batch Settlement Report.
        Supervisors/Leader must indicate on the Close counter statement after identify patient bill details when there are missing slips.
        
        Credit card
        
        Total count and amount of approved sales slips must tally to BOTH detailed and batch settlement report.
        
        Void sales slip must be submitted to Business Office
        
        If there is missing slips, must identify patient's bill details and make an indication on Close Counter Statement
        
        Cancellation of receipt:
        
        Cancellation of receipt has to be attached in close counter statement and be recorded in cancellation of receipt form.
        
        Clinic/Location Manager will verify before submitting to business Office
        
        Refund
        
        Front-end Refund
        
        Upfront cash refund if customer requires the refund immediately
        
        Updated invoice and SAP refund form is required to be printed out for patients to acknowledged cash refund by signing on the said form.
        
        SAF refund document is to be enclosed with daily close counter statement and send to clinic/location manager for verification and submission to business office
        
        Back-end refund
        
        Since the customer has left the building, the refund is initiated through the refund requested form.
        
        Manager/Supervisor/Executive in charge at the department must complete and sign the form before submitting to business office.
        
        Possibilities of excess:
        
        Forget to indicate the discount amount
        
        Wrong service charge
        
        Key in wrong amount
        
        Possibilities of shortage:
        
        Fraud
        
        Negligence
        
        Transaction error
- - - - Credit Card Charging Processing:
        
        Present credit card to merchant as payment
        
        Merchant accepts card and sends transaction details to payment processor
        
        Processor forwards transaction details to credit card company's network
        
        Card company routes transaction details to card issuer for authorization
        
        Issuer approves transaction and sends notification back through same channels
      - Avoiding AR
        
        The effective way to reduce AR is to collect charges at the time of services. All payment should be collected at the time of registration, before the physician sees the patient.
        
        Patients with co-payment (e.g. the *80% of the insurance, 20% out of pocket by patient) could be charged at the time of service.
        
        Provide staff at the checkout with the insurance payment schedule for those services provided, along with the pre-calculated co-payment amount (e.g. 20%)
      - Refund
        
        Return of medications
        
        Service paid but not performed
        
        Lapse in service provided
        
        Overcharge of service rendered
        
        Deposit balance fro surgery
        
        Duplicate payments