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Lesson7: Documentation and Inflight Management (Inflight Management…
Lesson7: Documentation and Inflight Management
Information needed
SOC
Patient details: IC, name, DOB, address
Other necessary information: contact number, 3rd party payers, NOK info, referral source
General information
Document type (data in identification document, eg. NRIC, Work Permit)
Case type (Outpatient)
Visit type (first visit, follow-up visit)
Referral source (polyclinic, GP, self-referral)
Payment Class (SC, PR, FR, NR)
Attending service provider
polyclinic
Patient classes: Singapore Citizen, Permanent Resident, Foreign Resident, Non-Resident
a. Adult
b. Elderly
c. Children
Documents required: identification documents (NRIC, Work permit, employment pass, passport
A&E
Patient Classes: SC, PR, FR, NR
Documents required:
identification documents (NRIC, Work Permit, Employment Pass, Passport)
referral documents (from polyclinics, other hospitals' A&E, CHAS GP, Non-CHAS GP)
public hospital
Patient classes: SC, PR, FR, NR
Documents required:
identification documents (NRIC, Work Permit, Employment Pass, Passport)
referral documents (from polyclinics, other hospitals, A&E, SOC)
Medical Claims Proration System (MCPS)
Secure web-based medical benefits and claims processing/proration system that helps Singapore Civil Service to centrally manage and process employee healthcare benefits
Integrated with healthcare providers, insurance companies and various government agencies, has significantly streamlined medical claims processes, ultimately enabling public service employees to enjoy medical benefits at clinics and hospitals
May not be a valid Civil Service Card (no entitlement)
Patient may no longer be employed under civil service
Civil Service Card may no longer be valid
Inflight Management
Payment versus Deposit
payment is treated as money paid for services rendered
deposit is deemed to be monies that may be refunded
Ward Centric Collection
PSA tasked with monitoring debt of patients
advantage: staff located in the wards and is able to detect visitors of patients
disadvantage: staff has to multi task, work and information involved in financial management is intensive
Patient Centric Collection
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
advantage: staff are centrally located and smaller team is required. Intensive training and information is readily offered
disadvantage: staff must proceed to wards to liaise with patients and family members
Hybrid model is better than both because it promotes:
economies for scale
geared for seasonal variation and shared goal
standardisation and dissemination of best practices
Interim bill: given to collect any cash outstanding before patient leaves the hospital; ensure patient is aware of his medical bill upon discharge as a final copy will be presented immediately due to CCPS processing
Discharge summary: provides details of the patient medical condition, given to patient in the event that the Employer or Insurer needs the medical information for processing of medical bills
Credit Assessment
Ranking A: SG (PTE/SUB) [MCPS Copayment Ward Scheme; Premier Private Integrated Plan Insurance Scheme; Must signed Letter of Undertaking]
Ranking B: SG (SUB) [Public Assistance Card or similar Assistance Scheme; CPF related Insurance Schemes and Medisave minimum balance $3,000; Minimum cash deposit $3,000 or as per bill size; Sufficient 3rd party coverage; must signed Letter of Undertaking]
Ranking C: SG (PTE) or PR (PTE/SUB) [CPF related Insurance Schemes and Medisave minimum balance $6,000; Minimum cash deposit $10,000 or as per bill size; Sufficient 3rd party coverage; must signed Letter of Undertaking]
Ranking D: NR or FR [Minimum cash deposit $10,000 or as per bill size; Sufficient 3rd party coverage; Employer is credit worthy with Letter of Undertaking; must signed Letter of Undertaking]
Ranking E: SG (PTE/SUB) or PR (PTE/SUB) or FR or NR [Unable to establish patient identity or citizenship status; Sourcing for 3rd party coverage]
Ranking F: SG (PTE/SUB) or PR (PTE/SUB) or FR or NR [Confirmed Specific Bad Debtor]
Credit Followup
Ranking A:
active follow up not required as patient will not default payment
check for non treatment related items with huge costs, cash payment is required
update patient of bill size every 5 working days
bill various payers and monitor for payment
close case upon payment
Ranking B:
check folder every 3 days to monitor bill size
if bill size exceeds coverage, request for top up of deposit/coverage
repeat step 1
if there is no additional deposit/coverage, refer patient to MSW and accord F grade
dunning cycle persists until payment is obtained
outsourced if payment is not forthcoming within 90 days
if write off balance is above $1000, FCO must account for the bad debt and not rating patient with F grade
close case upon payment or write off
Ranking C:
check folder every 3 days to monitor bill size
if bill size exceeds coverage, request for top of deposit/coverage
repeat step 1
if there is no additional deposit/coverage, accord F grade
dunning cycle persists until payment is obtained
outsourced if payment is not forthcoming within 90 days
if write off balance is above $1000, FCO must account for the bad debt and not rating patient with F grade
close case upon payment and write off
Ranking D:
check folder every 3 days to monitor bill size
if bill exceeds coverage, request for top of deposit/coverage
repeat step 1
if bill size exceeds 15k and no additional deposit/coverage, turn to F grade
dunning cycle persists until payment is obtained
outsourced if payment is not forthcoming within 90 days
if write off balance is above $1000, FCO must account for the bad debt and not rating patient with F grade
close case upon payment or write off
Ranking E:
contact patient/nok/employer for documents and deposit/coverage
within 3-5 days after admission, if no documents or deposit/coverage is given, change patient rating to F grade
if document/deposit/coverage is received, turn patient to the relevant grades
Ranking F:
all cases above $1000
highlight to SMM
PTE class: contact patient/nok for downgrade procedure (for bill size above 15k, do force downgrade)
FR and IA: send bill via registered mail to company for payment as legal evidence; report to MOM and Label Company as potential bad debtor
SG and SUB: refer to MSW for assistance. Highlight as potential bad debtor; if medifund assistance confirmed, accord B grade
write off case upon final billing