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Jenna MP - Financing for Healthcare (Lesson 1 to 12) (Counter Collection,…

- - - - Covers 20 Chronic Conditions under the CDMP
      - Purpose
        
        Provided to Singaporeans who are in Lower to Middle income household. So that they can have better access to Primary healthcare and be able to afford for healthcare treatment.
      - People who have the CHAS Card can be able to get subsidies at the selected dental services and recommended health screening under the HPB (Health promotion Board) and ISP (Integrated screening programmed)
      - Blue Card
        
        Monthly Household Income: $1,110 and below
        
        Annual Value of Home [For household with no Income: $13,000 and below
        
        Common Illness: Subsidies up to $18.50 per visit
        
        Chronic Condition under CDMP
        
        Simple: Up to $80 per visit and Up to $320 per calendar year
        
        Complex: Up to $120 per visit or $480 per calendar year
        
        Selected Dental services: Up to $11 or $256.50 per procedure
        
        Subsidies for SOC:
        70% Subsides for Services
        75% Subsidies for Medication
      - Orange Card
        
        Monthly Household Income: $1,101 to $1,800
        
        Annual Value of Home [For household with no Income: $13,001 to $21,000
        
        Common Illness: Not Applicable
        
        Chronic Condition under CDMP
        
        Simple: Up to $50 per visit and Up to $200 per calendar year
        
        Complex: Up to $75 per visit or $300 per calendar year
        
        Selected Dental services: Up to $65.50 or $170.50 per procedure for selected procedures {Dentures, Crowns, Root Canal Treatment}
        
        Subsidies for SOC:
        60% Subsidies for Services
        75% Subsidies for Medication
      - Green Card
        Available on 1 Nov
        
        Monthly Household Income: Above $1,800
        
        Annual Value of Home [For household with no Income: Above $21,000
        
        Subsidies for SOC:
        50% Subsidies for Services and Medication
      - Drug Subsidies
        
        CHAS (Blue and Orange):75% of subsidies
        
        People who did not Apply for CHAS: 50% of Subsidies
        
        Pioneer Generation: Additional 50% off subsidies
      - Pioneer Generation Package
        
        Purpose: To Recognize & Honor the PG
        
        Criteria:
        
        Singaporeans who were 65 years or older in 2014
        
        Born on or Before 31st December 1949
        
        Became a Singaporean by 31st December 1986
        
        Subsidies
        
        Additional 50% off subsidies for Service & Medication at SOC and Polyclinic
        
        Enjoy Subsidies at Participating GP and Dental clinic under CHAS
        
        Additional 50% off medication listed under the SDL or MAF
      - Other Types of Subsides
        
        Day Surgery
        
        Singaporean: 65%
        Permanent Resident: 40%
        Foreign Resident: 0%
        Non-Resident : -30%
        
        Specialist Clinic
        
        Singaporean:
        
        Without MT:50%
        
        With MT: 60 to 70%
        PR: 25%
        FR: 0%
        NR: -30%
        
        Restructured Hospital {ILTC}
        
        Singaporean:
        
        Class C 80 to 65 %
        
        Class B2 65 to 30%
        PR:
        
        Class C 55 to 32.5%
        
        Class B2 40 to 25%
        
        Inpatient [Public Hospital]
        
        Singaporean:
        
        A and B1 class ward patient are considered private. Thus, no Subsidies given.
        
        Class B2: 65% ; Class C: 80%
        
        PR:
        
        A class ward patient have no Subsidies.
        
        Class B1: 10%; B2: 40%; C: 55%
        
        FR: Have to pay full rates {no subisides given}
        NR: Pay Surcharge
    - - Criteria:
        
        Singaporeans that were born from 1950 to 31 December 1959
        
        Became a Singaporean citizen on or before 31 December 1996
        
        Singaporean born on or before 31 December 1949
        
        Became a Singaporean on or before 31 December 1996
        
        Do not receive the PG package
      - All Medaka generation seniors received CHAS benefits, regardless of income or AV of home.
  - - - 1. Lump Sum Subvention:
        
        Operating Funds given to a healthcare institution based on budgetary forecast
        (Superseded as it fosters a growing budget)
      - 2. Piece Rate Subvention:
        
        Funds awarded based on the total number of patient days and volume of outpatient consult episode consumed. Funding is based on usage
        (Not ideal funding as it is prone to abuse, the more one consume, the greater the funding. Length Stay of the patient will be extended.)
      - 3. Casemix Subvention:
        
        Funds allocated based on DRG (Diagnostic related group). Every DRG depending on the complexity of treatment will command a different subvention amount.
      - 4. Global Budget Subvention:
        
        Funds allocated based on lump sum, piece rate and case mix funding principles
        (Now it is adopted as it is a feasible funding model for less common DRGs)
  - - - It is a basic health insurance plan that helps patient cope with large hospital bills and selected costly outpatient treatments
    - - 2 Components:
        - Medishield Life
        - Private Medical Insurance coverage {The private insurance coverage is an additional insurance plan that can help to cover medical bills for patient in the B1 and A class wards}
      - It is managed by the private insurer
  - - - Benefits:
        
        Can help to reduce the burden of long term care. Due to the raising healthcare cost some opt to upgrade to Eldershield Supplement
    - - Advantages of CareShield Life:
        
        Higher Payout that increase over time {Starting $600 per month in 2020 and payout increase until age 67}
        
        No cap on payout duration
        
        To provide better protection against the uncertainty of Long term care $ if you become severely disabled
  - - - 1. Personal Responsibility
        
        Patient expected to co-pay according to ability
        
        In Singapore we offer basic & quality healthcare
      - 2. Medical Necessity
        
        Based on necessity, hence exclude non-essential choice (eg: Class A wards, Cosmetic surgery)
        {Eg: Anything that is link to cosmetic surgry you cannot pay using Medifund)
      - 3. Family Responsibility
        
        Used immediate family members Medisave where possible
        
        Need to ask family member to help .
      - 4. Many Helping Hands
        
        Medifund to complement and not to replace charity funds
        
        Encourage philanthropy to provide addition assistance
    - - Singaporean
      - Received treatment as Subsidized patient (B2 or C) for inpatient and subsidized outpatient
      - Received treatment from a Medifund-approved institution
      - Unable to pay healthcare bills despite receiving government subsidies and drawing on other means of payment including the other 2Ms and cash
    - - Eligible for Singaporean age 65 and above
      - Purpose: To deal with ageing population
    - - Helps children healthcare bills & middle income to low income families
      - Eligible for Singaporean Children aged 18 and below
      - Helps to defray cost incurred by children diagnosed with congenital or neonatal condition
    - - Medical social worker will need to do a financial assessment
        
        Your wife and husband
        
        Your Parents
        -Your children include children who are married or staying apart.
        
        Any relative who are staying with you at the same household
        Document for Financial Assessment:
        
        Your bankbooks or bank statement
        
        Your wife or husband bankbook
        
        NIRC of your family members
        
        CPF statement for all family members between 21 to 65 years old
    - - Household income = Monthly per-capita household incomre (Gross income net of CPF deduction) - After CPF deduction
    - - Medifund (General)
        
        Less than or Equal to $A - 100% eligible
        $A to $B - Frm O% to 100%
      - Medifund Silver
        
        Less than or equal to $B - 100% eligible
        $B to $C - Frm 0% to 100%
    - - Separate funding from Medifund
      - Helps lower income patient who may no be considered level 2 application
      - Maximum subsidy level 75% upon assessment by MSM for drugs
      - Per capital household income of $1,500 or less
    - - Expand MAF to cover Non-standard drugs and Non-formulary drugs
      - Expand MAF to include NSDL drugs
      - Increase maximum subsidy level from 50% to 75% upon assessment by the Medical social service
      - Must deducted first before using patient Medifund or Medisave
    - - Level 3: Non-Straight Forward Application
        
        Using the income guidelines scale and patient request to have more usage of the Medisave.
      - Level 2: Straight Forward (SF) Application
        
        Using the Income guidelines scale and patient accept the percentage of being able to use Medifund.
      - Level 1: Pre-Qualified Cases
        
        Whereby patient is automatically able to use Medifund without further assessment. (Eg: Patient with Public assistance card)
  - - - It is a national saving scheme that helps individuals set aside part of their income to pay for their personal or immediate family medical bills.
      - * Immediate family members are:
        
        Parents
        
        Spouse
        
        Children
      - It is portion of your CPF account
      - Medisave can helps to pay for Medishield Life premium. However, it cannot helps to pay for Nursing homes or Long-term care
    - - 1. 'Stay Healthy'
        
        Can be used at the GPs, Polyclinic and SOCs
        
        For Outpatient preventive care and Chronic treatment
        
        To protect yourself against diseases
        
        Approve vaccination for targeted population
        
        Pneumococcal vaccinations
        
        Some Examples
        
        Hepatitis B vaccination
        
        HPV vaccination
        
        Recommended Screening
        
        Mammograms for women aged 50 and above
        
        Selected screening test for new-born in Outpatient setting
        
        Hearing test
        
        G60 deficiency screening
        
        Metabolic screening
        
        Thyroid function test
        
        Chronic disease is under CDMP
      - 2. Starting a Family
        
        For couple who may need help conceiving
        
        $6,000 -1st Child
        $5,000 - 2nd Child
        $4,000 - 3rd Child
        
        Subject to a lifetime limit of $15,000 per patient
        
        Treatment cycles respectively for Assisted Conception procedures (ACP)
        
        When Welcoming your little baby
        
        Hospital charge $450 per day include daily ward charges , daily treatment fees, investigation and medicines
        
        Delivery procedures - $750 for normal delivery & $2,150 for Cesarean delivery
        
        Pre-delivery expense - an additional $900 which include consultation ultrasound , test and medication
        
        Total Claimable
        
        Natural Delivery
        
        Delivery Procedure = $750
        
        Pre-delivery = $900
        
        Hospitalization (3 days x $450) = $1,350
        
        Total = Up to $3,000
        
        Cesarean
        
        Delivery Procedure = $2,150
        
        Pre-delivery expenses = $900
        
        Hospitalization (4 days x $450) = $1,800
        
        Total $4,850
        
        For the 5th and subsequent children - Medisave can be used only when Spouse + Self medisave balance is = $15,000 or more.
      - 3. For Repeated Treatment
        
        Medisave for conditions that required prolonged, regular treatment and may be costly overtime.
        
        What are the health conditions?
        
        Cancer (At SOCs)
        
        Renal dialysis - $450 per month per patient
        
        Outpatient intravenous antibiotic treatment (SOCs) - $600 per week cycle{up to $2,400 a year}
        
        Selected drugs, service or devices (At SOCs)
      - 4. Old Aged Treatment
        
        Getting Medical scan (At SOCs and Polyclinic)
        
        $300 per year patient for scans needed to diagnose/treat medical conditions
        
        Medical scan:
        
        CT or MRI scan
        *Note: Not for plain X-ray or scans which are already covered under other medisave uses. (eg: Pre-deliver scan)
        
        For treatment in Old Age (at Polyclinc, Public Hospital SOCs and Participating CHAS GPs
        
        Flexi-Medisave
        
        $200 per year per patient under Flexi-Medisave for Outpatient medical treatment
        
        Applicable for aged 60 and above
        
        Use your own Medisave / spouse's medisave if her or she is aged 60 or aboce.
        
        Covers consultation fees, Medical service, Drugs and Test necessary for diagnosis or Treatment of a medical conditions by doctor.
        
        For example:
        
        If a taxi driver have eyes infection and wants to used Medisave to pay for his bills. The doctor can make the order as a medical conditions as it related to his work.
        
        Does NOT apply to Dental treatment
      - 6. Regaining Mobility after hospitalization and Palliative care
        
        Rehabilitation
        
        Inpatient at Community Hospital
        
        $250 per day, Up to $5,000 per year
        
        Out patient At a day rehab center
        
        $25 per day, Up to $1,500 per year
        
        Palliative Care
        
        Inpatient Hospices
        
        $200 / day
        
        Home Palliative Care
        
        $2,500 / Lifetime
        Note: If you have terminal cancer or End stage organ failure, there is no limit and you can used full Medisave balance
      - 5. Going for Surgery or Hospitalization
        
        For Hospitalization
        
        $450 per hospitalization day
        
        Include Hospital charges, Daily ward charges, Daily treatment fees, Investigation and Medicines
        
        $300 per day surgery episode
        
        For Surgery
        
        *Claims are based on Fixed limit from the TOSP
        
        $250 to $7,550 depending on complexity of the surgery
      - 7. Paying for Medical and Long term care insurance
        
        Eldershield and ElderShield Suppliments
        
        To protect our elderly against Long term care expenses
        
        Eldershield Premium can be used FULLY paid by Medisave
        
        Use up to $600 of Medisave per year for Eldershield supplement
        
        MediShield Life and Private Integrated Shield Plans
        
        It is a basic insurance scheme which helps Singaporeans to pay for large hospital bills and expensive outpatient treatment
- - - - Alexandra Hospital
      - Changi Hospital
      - Kandang Kerbau Hospital
      - Meddleton Hospital
      - Singapore General
      - TTS hospital
      - Toa Payoh hospital
      - View rd hospital
      - Woodbridge Hospital
  - - - Leading to better service and Lower costs
      - Centralization Through Clustering
        
        Group Purchasing Office (GPO)
        
        Allow Bulks purchase of Medical consumables and materials.
        
        Purchase Increase leverage of Hospitals to demand lower prices.
        
        Advantage:
        
        Standardization of cost prices throughout the cluster
        
        Financing Shared Services (FSS)
        
        It is an outsourced accounts payables, account receivable and payroll services provider to various NHG or SHS group and other related companies
        
        Backed Accounting function are consolidated or Shared to reduce the manpower and operating cost
        
        Integrated Health Information System (IHIS)
        
        Conveived in 2008 by MOH
        
        Central employer for all public healthcare IT professional
        
        Creates Cost Saving through consolidation
      - Competiton
        
        Creates Price Diversity
        
        Result in Price Variation.
        
        Prices are marked up to cover the costs of institution.
        
        Cost can be reduced by consolidating common services for healthcare institution
        
        Amidst Regulation
      - National Healthcare Group & SingHealth
  - - - Alexadra Health system
      - Eastern Health Alliance
      - Jurong Health Service
        
        It moves to 3 Cluster
        
        National University Health System
        
        National Healthcare group
        
        Singapore Health services
      - National Healthcare group
      - National University health system
      - Singapore Health service
- - - - Total claims made by the insured will always be = total medical expenses incurred
        
        Claims processing rules requires submission of Original Bills
- - - - It is requires as to save the patient and families from financial burden
    - - Choice of class
        
        Primary private
        
        Primarily Subsidized
      - To proceed OR not proceed with treatment
      - Seek Alternative options at other institutions
      - Standard Or Non-standard drugs
  - - - Upgrading to higher ward class, all charges (except patient daily standard ward fees) incurred at the lower ward class up till the upgrading will be charges at higher rates
      - Eg: If you stay in C class ward and you have upgraded to move to B1 class ward. The next time you admitted to the hospital you are considered a Private patient
    - - Patient can be downgraded from Private to Subsidized ward class. However Need to do Mean testing
      - Based on the Monthly household income
    - - Subjected to availability of beds and take effect when the patient physically occupies the lower or higher class bed.
      - Depends on the bed available
    - - Class A or B1 patient will be charged at Private rate
      - Class B2 or C patient will charged at Subsidized rate {Only for Singaporean and PR}
      - All other citizenship will be charged at private rate
      - Industrial accident hospital will charged as A rate
    - - Not applicable for Class A ward
      - When patient don't go home despite doctor allow discharged
      - Respectively
        
        Description Class B1 ; Class B2 ; Class C
        
        Ward charges 235 ; 200 ; 170
        
        Daily Treatment Fee 90 ; 90 ; 90
        
        All procedures and Services discharge medication Full Rate ; Full Rate; Full Rate
- - - - Use for inpatient admission
      - For employed
        
        Based on Average monthly income received over the 12 month period (Bonus -> But not the last salary is included for calculation
        
        CPF will not affect the income information
      - For Self-employed
        
        Based on monthly income from the last avail net trade income by the IRA
        
        Income declared to CPF board withing that last 2 yrs
      - For Unemployed & No inome
        
        Received full subsidy (65% for class B2 and 80% for Class C ward
        
        BUT if they live in the property with annual value more than $11,000 -> They will be given 50% and 65% respectively for class B2 and C
        
        Look at the house Annual value
    - - Use for
        
        Inpatient Downgrading
        
        SOC enhanced subsidy
        
        ILTC Subsidy
        
        Community health assist scheme application
      - Calculation:
        Per capital monthly household income
        = Gross income of person needing care, His/her spouse and all immediate family members living in the same household / Total number of family members living in the same household OR Annual value of place of residence for hosuehold with no income
      - Family members include:
        
        All related family members (blood, marriage or legal adoption
        
        Staying at the same residential address with the patient
- - - - Patient IC No.
        
        Name
        
        DOB (Date of Birth)
        
        Address
    - - Contact No.
        
        3rd Party Payers
        
        NOK Information
        
        Allergy Information
        
        Referral Source
  - - - 1. Polyclinic
        
        Identification doc
        
        NIRC, Birth Cert, Passport, Work permit, Employment pass
      - 2. A&E in Public Hospital
      - 3. Public SOC
        
        i) Identification Document
        
        NIRC, Birth Cert, Passport, Work permit, Employment pass
        
        ii) Referral Document
        
        From Polyclinic, CHAS, GP, Non-CHAS GP
      - 4. Public Hospital
  - - - May not be a valid civil service card
      - Patient may no longer be employed under civil service
      - Civil service card may no longer be valid
  - - - Payment is Treated as money paid for service rendered
      - Deposit is deemed to be monies that may be refunded
    - - There are A to F rating and each rating have different follow up action. (Refer to 6Ps for more info)
      - If a patient comes in and get knocked down by the car and unconscious what rating should the patient be in?
        Answer: Patient will be placed under E rating as healthcare staff unable to identify patient.
    - - Definition
        
        PSA or Ward Clerks are tasked with monitoring the debt of patient
      - Advantage
        
        Stuff are located in the wards and is able to detect visitor of patient
      - Disadvantage
        
        Staff has to multi task, the work and information involved in Financial management is intensive
      - Hybrid Model
        
        As it Promotes:
        
        Economics of scale
        
        Geared for Seasonal variation and shared goal
        -Standardization and Dissemination of best practices
    - - Defination
        
        A team of PSA is located in a central location away from the patient. Having access to patient Financial data and review the debt situation remotely
      - Advantages
        
        Staff are centrally located and smaller team is required.
        
        Intensive training and information is readily offered
      - Disadvantages
        
        Staff must proceed to the wards to liaise with patient and family members
      - Specific Bad Debt provision
        
        Patient with "F" credit rating must be submitted to finance for bad debt provision. The bad debt must be communicated to the finance dept
- - - - Patient Information
      - Item Description
      - Quantity
      - Service Code
      - Acknowledgement of Data entry completion
  - - - Data entry clerks are sited in an area away from where the service are performed.
      - A Single Staff is responsible for Data entry work
      - Advantage
        
        Sense of accountability for appropriate charging from the charge analyst
      - Disadvantage
        
        Possible of High $ as resource of charge analyst
    - - Data entry clerks are sited in the ward or where the services are performed
      - Team of Staff is Responsible
      - Advantages
        
        Manpower need is lower through multitasking of staff
      - Disadvantages
        
        Daily charge often Delayed, Not performed
  - - - Billing system by billing staff (Use of charge forms)
    - - Interface of services from ancillary medical system to billing system
      - ONLINE:
        
        Interface system, transactions are processed as and when they are entered
      - Batched
        
        To collect transactions over a period of time and then process all of the transaction at once.
        
        Benefits:
        
        Can shift time of job processing
        
        Avoids idling the computing resources
        
        Keeping high overall rate of utilization
        
        Allow system to use different priorities for batch and interactive work
        
        Allow effective use of manpower
      - Key Concerns
        
        Quantity cannot be 0
        
        Services must be performed withing Length of stay
        
        0 priced items are allowed
        
        Service codes are not avail -> Miscellaneous codes may be used
        
        Miscellaneous charge code is Employed with price determined by a mark up table
        $10 = 60%
        $10 to $15 = 50%
        $16 to $50 = 40%
        $50 to $100 = 20%
  - - - Bill has to be opened or cancelled if it has already close
  - - - Defined by a list of items and quantity
    - - Defined by a price tag to treat a specific medical condition
    - - Package covers all pregnancy-related consultations after 20th week pregnancy.
      - Postnatal consultation
      - Ultrasound obstetric scans
      - All clinic consultations
  - - - Before 1pm, no charge is imposed
      - After 1pm, a quarter day ward charge is imposed
      - After 6pm,a full day ward charge is imposed
  - - - A service code that trigger a discount effect on the entire bill
    - - Service code that trigger a surcharge effect on the entire bill
    - - Code that impose a surcharge on certain service only
- - - - All B2/C patient are given a 50% subsidy for these items up to a maximum subsidy of $500
  - - - This is when the bill is closed and new charges cannot be input anymore. But not ready to generate
    - - All service rendered has been keyed in the system and ready for generate.
      - If patient require to print another copy there will be a "Duplicate" Stamp
    - - This is when Bill is open and new charges can be added.
- - - - Close counter statement
        
        Vendor trust receipts
        
        Detailed report
        
        Batch settlement report
        
        Credit card sales and NETS slops
        
        Any other supporting doc
- - - - Collection of money Directly from Patient
    - - Patient pay their medical bills through other agencies
        
        Examples of 3rd party claim
        
        Private insurance
        
        CPF Board (Medisave, Medishield Life, and Integrated shield plan(IP)
        
        Civil service (Employee Medical Benefits)
  - - - Advantages
        
        Payment are guaranteed
        
        Direct credits to institution account
      - Disadvatnages
        
        Longer processing time
        
        Difficult for staff to keep track of the different
        
        System update needed for any changes of schemes
    - - Advantages
        
        Need not pay up front
        
        Co-payment by the organization they belong to
      - Disadvatanges
        
        Does not cover all medical expenses
- - - - Payment amount may not tallied with outstanding amount
    - - Payment from other payment modes may take longer time to clear and the billing system may not reflect the correct payment status.
  - - - Simple Transaction Process
        
        1.Present your credit card to merchant as payment
        2.Merchant accept card and send transaction details to payment processor
        3.Processor forward transaction details to credit card company
        
        Card company routes transactions details to card issuer for authorization
        
        Issuer approves transactions and sends notification back through same channels
    - - There is also a delay in receving the money from Crdit card and NETs tasactions
  - - - Shows service that is rendered and payment not collected
      - Management Perceptive:
        
        AR reports will identify problems with your receivables management process
      - Operation Perceptive:
        
        AR reports identify account that require collection action
    - - Commonly used
      - Report should stratified by
        
        Payer
        
        age
        
        balance amount
    - - Collect charges at the time of service. All payment should be collected at the time of registration before the physician see the patient.