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Financing For Healthcare (P12: transaction posting (nets (benefits:…
Financing For Healthcare
P7: Documentation, Inflight Management and Costing
Necessary Information when registering patient in public SOC
- Patient NRIC
- Name
- D.O.B
- Address
Others:-
- Contact Number
- Third Party payor [e.g: MediShield, NTUC income]
- NOK information
- Allergy information
- Referral Source
Documents needed for registration:-
- Document types [NRIC/ Work Permit]
- Case type [Outpatient/ Inpatient]
- Visit Type [First visit/ Follow up]
- Referral from GP/ Polyclinic
- Payment class
Determining Patient Class
- Polyclinic - SG, PR, FR, NR
- Adult
- Elderly
- Children
Documents:- Passport/ NRIC/ Work Permit
- A&E Dept
- SG, PR, FR, NR
Documents required
- Identification Documents [NRIC/Passport]
- Referral Documents from polyclinics/ GP
- Public SOCs
- SG, FR, PR, NR
Documents
- NRIC/ Passport/ Employment Pass
- Referral Documents
- A&E, CHAS GP/NON CHAS
MCPS
- secure web based medical benefits & claims processing system
- helps SCS to manage employee healthcare benefits
Inflight Management
- Payment treated as money paid for services rendered.
- Deposit is deemed to be monies that may be refunded.
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.
Specific Bad Debt
- 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.
Purpose Of Discharge Summary
- Provides details of the patient medical condition.
- 1 more item...
P10: counter collection
Payment Modes:
NETS,
cash,
cash card,
credit cards,
cheque
shortage:
- happens when the amount stated in the system is less than the actual collection
- where a shortage is recorded, it is to be topped up on the same day and banked in together with the current day's collection
excess: any excess cash collection should be banked in together with current day's collection
- cashier/collection staff need to indicate explanation for excess
to prevent fraud; the cashier is required to enter the total amount from his/her counting of his/her collection & the amount should reconcile
credit card transactions:
- cashier needs to print the detailed and batch settlement report from the credit card terminals
- supervisor has to ensure that sales slips are duly signed by cardholder.
- amount must tally
security features:
- the camera should be positioned to capture the face of the person
opening the safe
- the safe should be located in an enclosed room with a door secured with a lock
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P11: claims processing
advantages of payments via claims for patients:
- Need not pay up front.
- Lesser co-payment by the organisation they belong to
advantages of payments via claims for healthcare:
- Direct credits to institution’s account.
- payments are guaranteed unless patient is no longer entitled or covered under the scheme
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possible issues
Rejected claims that has not been processed by the insurer due to error in the information provided such as personal information is not accurate so it cannot be appealed
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Wrong information of patient. For eg:- Wrong name, birth dates, age
Not entitled for claim processing such as cosmetic items/services. eg:- botox, breast implant, nose job
Patient are no longer qualify for 3rd party payer such as no letter of guarantee from company/ not covered by insurance company
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P12: transaction posting
nets
benefits: Transaction made electronically, secured payment.
constraints: Unable to revert the transaction once approved, only can refund via cash or cheque and processing fee is applicable
cash
benefit: quick & easy, transactions are completed immediately. cash can be used for the next transaction
constrains: Physical counting and tallying of amount required. May be stolen if not proper security in safe guarding the cash.
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P8 Charging
- A charge form is a document used by nurses 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 the bill must be reconciled with the charged form.
Charging requires a form with:-
- patient information
- item description
- quantity
- service code
- acknowledgement of data entry completion.
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Consumables or Implant Charging
- mark up table used IF medical item used is NEW and service code has NOT been created
Charge entry
- Charge entry is a service that has been performed and is pending data entry.
Closing The Bill
- refers to the instruction issued to the billing system to stop accepting service entries/ charge code entries for an account.
Late Charge
- hospital billing:- bill has to be opened or closed if it has been billed before any late charge can be entered.
Packages
- Item based package:- a package defined by a list of items and quantity.
- Dollar based package
- a package defined by price tag to treat a specific medical condition.
Maternity Package
- Mode of Delivery; Normal/ Caesarean
- Length of stay
- Hospital Charges e.g: A1 - B1
Antenatal PAckage
- all pregnancy-related consultations after your 20th week pregnancy
Includes:
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All clinic consultations with your obstetricians from the 20th week of your pregnancy till the birth of your baby.
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order entry
- Order entry is a service that has not been performed and is pending data entry.
P9: Billing
Billing
- is defined as the generation of an invoice for the purpose of payment collection from a customer
Fee Cap Inpatient
- Fee cap were introduced in 1984 for Class B2 and C patients
- Purpose is to ensure that subsidised patients would not be put to excessive difficulty in meeting the revised hospital charges due to unnecessary tests/investigations.
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