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Lesson8: Charging (Characteristics of good charging process (Comprehensive…
Lesson8: Charging
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Late charge
bill has to be opened or cancelled if it has already been closed or billed, before any late charge can be entered
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subvention and CCPS submission of claims will be compromised by the issuance of debit or credit notes
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penalty may discourage discharge, patient rather discharge prior to 6pm since they had paid the penalty
furthermore, prorated ward charge does not attract Medisave withdrawal
Terminologies
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"closing the bill": instruction issued to the billing system to stop accepting service entries/charge code entries for an account
- service entered after a bill has been closed in termed a late charge
Cite a case whereby surcharge is employed
- due to high cost involved in managing medical tourists, a surcharge is imposed to recover the promotion, commission, translation, chauffeuring services etc
Exploding/battery code:
- the input of a single code, similar to a macro, that will automatically expands into multiple services
- primary purpose is to save time and effort in entering multiple keystrokes for data entry staff
- unlike package: does not have discounted price
Charge form
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elements in charge form: patient information, item description, quantity, service code, acknowledgement of data entry completion
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Charge capture process
Centralised Revenue Management Approach
- data entry clerks are sited in an area away from where the services are performed
- single staff is responsible for data entry work (Charge Analyst)
- advantage: sense of accountability for appropriate charging from the Charge Analyst
- disadvantage: possibility of higher cost due to the resource of a Charge Analyst
Decentralised Revenue Management Approach
- data entry clerks are sited in the wards or where the services are performed
- team of staff responsible (Doctors, Nurses, PSA/PCA)
- advantage: manpower needed is lower through multitasking of staff
- disadvantage: daily charge reconcilitation is often delayed/not performed at all as clinical staff may not understand the revenue aspect of patient care/secondary responsibility as care giver
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Packages
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Dollar based package: defined by a price tag to treat a specific medical condition, further defined by list of exclusion (similar to buffet meal)
Antenal package: covers all pregnancy-related consultations after 20th week pregnancy
- all clinic consultations with ostetricians from the 20h week of pregnancy till the birth of baby
- 2 ultrasound/obstetric scans (at 22 and 32 weeks) to monitor growth of baby
- up to 2 CTG sessions to monitor baby's heartbeat and movements
- 1 postnatal consultation
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Learning Trigger
Revenue Cycle
Middle [pricing, charge capture and methodology, health information management and clinical information, coding, third party reimbursement]
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Ways to mitigate risk
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Employment of technology to the daily charging practice
- improvement in overall charge capture, clinical documentation and reduction in back-end claim manipulation
- real time feedback to clinical staff allow generation of a clean, compliant and comprehensive claim
- ultimately, increase cash flow and generate increased bottom-line revenue
Back end [managed care contracting, claims processing, account resolution, denial resolution, payment posting]
Front end [scheduling and pre-registration, financial clearance, financial counselling, arrival and registration, denial prevention]