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Financing for Healthcare (Hospital bills (Charges (Charge form record…
Financing for Healthcare
Challenges
Ageing population
Increasing incidence of chronic illness
Increasing demand for more healthcare
services
Increasing demand for more affordable
healthcare
Quality & affordable basic medical services to all
Mutli-Pillared Systems & subvention
Medifund
Safety net for patients still have difficulties in paying the subsidised bill charges,
despite Medisave and MediShield Life
Only Singaporeans
General scheme
As a subsidized patients received treatments from Received treatment from a Medifund approved institution
Still unable to pay healthcare bills (even with Government subsidies and drawing on other schemes and insurance)
Household income
less or equal to $A = Up to 100% of eligible bill
$A to $B = From 0% to 100% of eligible bill
Inpatient Admission
Only Class C
patient will be able to enjoy 100% Medifund assistance
Medifund sliver
Singaporeans age 65 or above
Benefit more elderly patients & to deliver help to needy elderly patients
Household income
less than or equal to $B = Up to 100% of eligible bill
Household income $B to $C = From 0% to 100% of eligible bill
Medifund junior
Singaporean children age below 18
Help to cover healthcare cost
Targeting more financial assistance for needy families that consist of sick children
3 levels of approval
Level 3: Non Straight Forward Applications (NSF)
Based on household income, Recommended % is greater
than the eligible & approval from medifund committee
Medifund Committees
Things to take note
Income
Socio-economic background of the applicant
Size of the bill incurred
Outstanding amount
Any other circumstances that Medifund Committee deem as relevant to the application
Level 2: Straight Forward Applications
Recommended % based on Household Income same or lower same or lower than Eligible & approval at medical social worker (MSW) level
Level 1: Pre Qualified Cases (Auto)
Public assistance card & approval is exemption
Medifund ILTC Resident/Non Residential
Non residential ILTC services such as day rehab, homemedical and home nursing services
MediSave
For whom?
Self, spouse (elderly 65 & above), parents & children
Used at both public & private hospitals
Pay medical expenses
Stay healthy with outpatient preventive care & chronic diseases treatment
Can used for:
starting a family
repeated treatment
getting medical scan
treatment in old age
paying for medical & long-term care insurance
going for surgery or hospitalisation
regaining mobility (rehabilitation)
receiving end-of-life care (palliative care)
MediShield Life
Singaporeans & PRs
Catastrophic Medical Insurance
Targets subsidized class
Protection for life & existing condition
Pay less cash or medisave for large bills
Cover medical expenses for Class B2/ C at public hospitals
Benefits :check:
Higher claim limits
lower co-insurance rates
patients pay less and insurance pays more
Integrated Shield Plans
Components:
Medishield life (CPF Board)
Private Medical Insurance coverage (private insurers)
Benefits: :check:
Patient opt for class Class A & B1 wards in both public and private hospital
Government subsidies
(up to 80% in public hospitals)
Eldershield/ Careshield life
(replaced eldershield in 2020)
For ill or unable to work due to illness
Reduce burden of long term care
More support towards ageing population
Better protection against the uncertainty of
long term care costs (if become severely disabled)
Monthly payout to help with out-of-pocket expenses
Better protection & assurance in
4 ways:
1. Lifetime cash payouts
As long as the person is severely disabled
2. Payouts increase over time
starting $600 per month in 2020, increases until age of 67 or making claims (either one whichever is earlier)
3. Government Subsidies to make it affordable
If unable to pay premiums, no one will still lose the coverage
4. Premiums can be fully payable by MediSave
Subsidised & insurance scheme
CHAS
Provide Sinagporeans lower & middle income households with better access and affordable to patients at GPs & private dentists
Tiers
CHAS green (from 1 Nov 2019)
CHAS orange
CHAS Blue
Pioneer Generation (additional 50%)
Common illness
20 Chronic conditions under Chronic Disease Management Programme (CDMP)
Selected dental services
Recommended health screening under Health promotion board
Pioneer Generation Package
To honor Singaporean Pioneer generation
Who are 65 years or older in 2014
Born on or before 31 Dec 1949
Become singaporean by 31 Dec 1986
Additional 50% off
subsidised services & medications
at SOC & polyclinics
Subsidies at GP & dental clinics under CHAS
Medeka Generation
Outpatient
Special CHAS subsidies at CHAS GP & dental clinics
Additional 25% at polyclinics & Public specialist outpatient clinics
Born from 1 Jan 1950 - 31 Dec 1959; &
Become singaporean on or before 31 Dec 1996
Also given:
Born on or before 13 Dec 1949; &
Become singaporean on or before 31 Dec 1996; &
Do not recieve the pioneer generation package
Medications Assistant Fund
To help lower income households
Selected clinically-effective medications that would be expensive
Criteria:
Clinic evalution
Evidence of efficacy
Favourable safety profile
Ethical considerations
Medications Assistance Fund Plus
Cover non-standard drugs (non standard & non formulary)
Increase subsidy from 50% to 75%
Deduct first before using Medifund or Medisave
Criteria:
Appropriate & deemed necessary for treatments
Documented history of the effects towards the drugs or no other alternatives
Employer Medical
Benefit Scheme
Civil Service Medical Benefits:
Comprehensive Co payment Scheme (CCS)
Medisave cum Subsidised Outpatient Scheme (MSO)
Co Payment on Ward Charges Scheme (CPW)
Insurance concepts
Deductible
an amount that needs to pay for claims before any payout from Medishield
Co-insurance
percentage of claim that needs to pay on the portion claim above the deductible
Claim limits
to address excessive claims
Financing Counselling
Financial impact of the patient's medical treatment
Estimated bill size information of their treatments due to large medical bills
To save patients and their families from financial burden
Must be informed
Following decisions
Choice of class, Private or Subsidized
To proceed or not to proceed with treatment
Seek other alternative options at another institutions
Standard or non standard options
Means testing (preventing the rich patients from abusing the subsidies)
Individual means testing
inpatient admission
Household means testing
Inpatient downgrading
ILTC subsidy
Medifund application
CHAS
SOC enhanced subsidy
Mean testing bands for subsidised beds (Singaporeans)
Mean testing bands for subsidised beds (PRs)
Forms:
Consent form (government subsidy)
Pay slip
MT Declaration form
Consent to release (MDS/ MDSL information)
Estimated bill
Acknowledgement that FC is performed
Medisave Authorisation form
Subvention
Funding that is given to healthcare providers to provide subsidized services (class B2 &C)
To cover resources (manpower, equipment, buildings and etc.)
Lump Sum subvention --> Piece rate subvention --> casemix subention -->
global budget subvention (Current)
Management
Registration
Data obtained:
document type
case type
visit type
referral source
payment class
attending service provider
Credit assessment
A --> SG (PTE/ SUB)
B --> SG (SUB)
C --> SG (PTE) OR PR (PTE/ SUB)
D --> NR/ FR
E --> SG (PTE/ SUB); PR (PTE/ SUB); FR; NR
F --> SG (PTE/ SUB); PR (PTE/ SUB); FR; NR
hybrid model
combines government subsidies with patient co-payments
Hospital bills
Charges
Charge form
record services rendered by patient
reconciled & billing in charge form
Charge capture process:
centralized revenue management process
decentralized revenue management process
charging mechanism:
item based package
dollar based package
chronic diseases full withdrawal package
exploding code
discount
surcharge code
conditional codes
surcharge requirements of international patient or medical tourist
Characteristics
comprehensive
robust
flexible
timely
accurate
complete
Payment modes
cash
cash card
NETS
cheque
credit cards
PayNow/ PayLah
& etc.
Fee cap
(B2/C)
outpatient
implant
GST
(B2+/ B2/ C, day surgery, outpatients, SOC & polyclinic)
3 types of billing stages
Unbilled stage or interim bill
Provisional bill
Final bill
Cancelled bill & re-bill
Challenges
inaccurate service codes
system disruption
incorrect information
services not covered
etc.
Counter collection
Cancellation of receipt
(record in Cancellation of Receipt Form, attached Close Counter Statement)
Front-end Refund
(refund requested immediately by customer)
Back-end refund
(customer left vicinity & initiated through refund request form)
Walk-off
(receiving services or medication without payment)
Cash float
(beginning of session or day to provide change for customers)
Workflow (counter closing)
Claims processing
Claim process
Bill amendment flow
following details:
patient details
reason for amendment
authorization signatories
Errors:
Denied claims
rejected claims
insufficient information sent
wrong information sent
non claimable item sent
etc.
Reason (rejected claims)
Patients no longer eligible for 3rd party claims
Plan does not cover the service used
Insufficient amount in account
Wrong date of birth entered
Wrong 3 rd party payer
Rectification
Cancel provisional bill (open bill) amend bill details rebill (provisional bill)
OR
if no longer covered by the 3 rd party payer, send outstanding bill to patient for payment by other mode
Common 3rd party payors
Civil Service (employee medical benefits)
Private Medical Insurance (PMI ) companies
Private organizations/employers/insurance company of the patient (LOG)
CPF Patients’
Payments
Issues
reconciliation issue
delay in reflecting correct payment status
refund
(must be a credit balance in A/R in order for refunds to made)
Supporting documents
refund voucher & reason for refund
medication refund note from pharmacy
return the money or issue cheque/ bank transfer
attach all supporting documents
Issues
limited more of refund
monitoring required
potential fraud
Outsourcing
(business functions of another party)
bank reconciliation
refund processed directly from bank
payment posting outsourced to other financing companies
debt recovery
3rd party billing
issues
No proper understanding of business process from external parties
any rectification --> take longer time
may not be cost effective
