Please enable JavaScript.

Coggle requires JavaScript to display documents.

Patient revenue cycle (4: RECEIVABLES PHASE (P11: Claims Processing (Civil…

- - - - Patient Access "Front End"
        
        Patient comes in to register
        
        Ask for IC, work permit, referral letter, chas card
      - Charge Integrity "Middle"
        
        Pricing charges
        
        Coding
        
        Health information
        
        3rd party reimbursement
      - Patient financial services "Back End"
        
        Managed care
        
        Claims processing
        
        Account resolution
        
        Denial resolution
        
        Payment posting
      - Good Charging Process
        
        Comprehensive - have to capture all services given if not company lose money
        Robust - Prevent fraud, providing cctv to prevent cashier stealing money
        Flexible - All kind of charges and have to factor in when system is down
        Timely
        Accurate
        Complete - tardiness because healthcare allow patients to pay later
- - - - Medical claims proration system(MCPS)
        
        helps civil service to manage and process employee healthcare benefits
        
        enable public service employees to enjoy medical benefits at clinics and hospitals
    - - Rationale for financial counselling
        I. Choice of class, private or subsidized
        II. to proceed or not to proceed with treatment
        III. Seek alternative options at other institutions
        IV. Standard or non-standard options
        General rules and regulations
        I. Upgrading - request for higher ward class, all charges incurred at the lower class up till upgrading will be recomputed and charged at higher class rate
        II. Downgrading - downgrade from private to subsidized ward class if they pass the downgrading procedure
        III. Downgrading/Upgrading - is subjected to availability
        Follow up at specialist outpatient clinic after discharge
        I. Class A/B1 patients charged at private rate
        II. Class B2/C patients will be charged at subsidized rate(SG & PR only)
        III. Other citiznships will be charged at private rate
        IV. patients under industrial accident is charged at private rate