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Financing for healthcare (Lesson 10: Counter collection (payment modes,…

- - - - Services reconciled with charge form
        
        Charges reviewed regularly to ensure prices / services updated
  - - - Sense of accountability for appropriate charging from charge analyst
      - staff sited away from services
      - single staff responsible for data entry work
    - - Manpower is lower through multitasking of staff
      - staff cited near services
      - Team of staff responsible
  - - - directly entering services into billing system - use of charge forms
    - - entering services from ancillary medical to billing system - use various service stations
      - Batch vs online
        
        Batch - transactions collected and processes over a period of time
        
        Online - transactions processes as and when they are entered
      - Key concerns
        
        Quantity > 0
        
        0 priced items are allowed
        
        Services must be performed within length of stay
        
        Miscellaneous codes may be used
        
        When service codes are not available
        
        price determined by mark-up table
  - - - bill has to be opened / cancelled if it has already been closed or billed before late charge can be entered
      - Debit / credit note are not raised to manage these charges
      - Subvention / CCPS submissions of claims will be compriised
- - - - Traditional / 3 individual fee caps
        
        individual fee cap for individual services
      - Modern / 3 in 1
        
        Grouped fee cap for 3 services
  - - - as long as there is no cheaper alternative suitable
    - - not required to pay for GST
        
        Covered by MOH
  - - - closed to additional charges but not yet ready for generation
    - - services rendered has been keyed into system
      - bill returns from CPF board and is ready for generation
        
        original / duplicate bill
        
        original bill printed and given to patient
        
        stamped with "certified true copy" and signed by staff
        
        request for extra copies of bills results in duplicate bills
    - - open for additional new charges
    - - when bill is re-opened for addition of new charges
      - rebilled will be new bill
  - - - items grouped within bill summary code
  - - - subsidy rate set at 50%
- - - - enclosed with daily close counter statement and send to manager to verify and submit to business office
  - - - detailed reports (for credit transactions)
      - batch settlement reports (for credit card and NETS transactions)
      - vendor trust receipts (white copy)
      - credit card sales and NETS slips
      - close counter statement
      - other supporting documents
  - - - at end of day, the department cash float should be deposited into a different safe from counter cash collections
  - - - workflow makes patient pay first
      - special attention is paid to patient
- - - - civil service
        
        MCPS
        
        MBS
      - private organizations / employers / insurance companies of patients (Letter of Guarantee - manual claim)
      - CPF - patients own
        
        MediSave for CDMP
        
        Medishield
        
        Integrated shield plan
  - - - Supervisor in charge
      - Business office in charge
      - higher authority if amount exceeds a certain limit
    - - wrong source of referral
      - over /under billed
  - - - no longer civil servant
      - no longer covered by insurance
      - plan does not cover service used
      - insufficient amount in account
      - wrong DOB (CPF)
      - wrong 3rd party payer
- - - - Reconciliation issue
      - Delay in reflecting correct payment status
  - - - STEPS
        
        Present credit card to merchant as payment
        
        Merchant accepts and sends transactions details to payment processor
        
        Processor forwards transaction details to credit card company’s network
        
        Card company routes transaction details to card issuer for authorization
        
        Issuer approves transactions and sends notification back through the same channels
      - For typical transaction with a credit card in a four-party system, suppose the consumer pays 100.0 to the card issuer. The issuer might then pay the acquirer of the transaction 98.3 (keeping 1.7 as the interchange fee) and the acquirer might then pay 98.0 to the merchant.
        
        The merchant fee (also called merchant discount or merchant service charge) in this example would then amount to 2.0.
      - Credit card transaction example
        
        Flow of Payments
        
        Consumer payment to issuer (bank) $100
        
        Issuer (bank) payment to acquirer (visa/masters) $98.3
        
        Acquirer (visa/masters) payment to merchant $98
  - - - return of medications
      - service paid but not performed
      - lapse in service provided
      - over-charge of service
      - deposit balance from surgery
      - duplicate payments
    - - e.g. patient returns half the medication prescribed
    - - documents / processes required
        
        supporting documents
        
        refund voucher
        
        medication refund note
        
        approval from supervisors and finance department
    - - limited mode of refund
        
        mostly by cheque for cross day refund
      - monitoring required
        
        stages of refund
        
        refund approved
        
        cheque issued
        
        system updated
        
        cheque cleared
      - potential fraud
        
        cheque being issued to the correct
        
        patient may claim that they did not received the fund
  - - - business office assistant required to tally the handover confirmation report to vendor trust receipt
        
        amount credited to bank account on daily basis
        
        cash payments
      - tally handover confirmation report to bank statements of credit cards and NETS transactions
      - discrepancy
        
        business office assistant verify the discrepancy against the close counter statement
        
        once verified, adjustments will be posted in the SAP system to clear off discrepancy
      - shortage
        
        business office assistant will approach the cashier / collection staff to top-up the amount
    - - when amount in handover confirmation report tallies to amount credited to the bank
        
        business office assistant will perform cleaning to the main bank account on a regular basis
      - business office assistant will prepare the bank reconciliation monthly
        
        reviewed by the supervisor and executive
      - Copy of bank recon forwarded to the finance department for retention
  - - - external parties may not have proper understanding of business process of institutions
      - any rectification required by the institution may take longer time
      - decision to outsource may come from cluster and not necessary cost effective for all the institutions involved.
  - - - if bills is not paid within specific period, will be termed as bad debts
    - - identify problems with receivables management process
      - identify accounts that require collection action