Financing For Healthcare: Chapter 8 - 10 (Chapter 8 - Charge Capture…
Financing For Healthcare: Chapter 8 - 10
Chapter 8 - Charge Capture Process
Document to record the services rendered for a patient
Must have: Patient Information, Item Description, Quantity, Service Code & Acknowledgement of data entry completion
Human dependent and prone to error, subject to availability of staff to perform the work as opposed to automated entry by system.
2 approaches in managing the charge capture process.
Centralised Revenue Management Approach
Advantage: Sense of accountability for appropriate charging from the Charge Analyst
Disadvantage: Possibility of higher cost due the resource of a Charge Analyst
A single staff is responsible for the data entry work, Eg: Charge Analyst
Data entry clerks are sited in an area away from the services are performed.
Decentralised Revenue Management Approach
A team of staff is responsible. Eg: Doctors, Nurses. PSA/PCA
Advantage: Manpower need is lower through multitasking of staff
Data entry are sited in the wards or where the service is performed.
Disadvantage: Daily charge reconciliation is often delayed/ not performed at all as clinical staff may not understand the revenue aspect of patient care/ secondary responsibility as care giver
2 modes of services codes input:
Batch or Online interface of services from ancillary medical system to billing system. (entry of service items by the various service stations)
Usually used to collect transactions over a period of time and then process all of the transactions at once.
It avoids idling the computing resources with minute-by-minute manual intervention and supervision
It allows the system to use different priorities for batch and interactive work.
It can shift the time of job processing to when the computing resources are less busy.
It allows effective use of manpower, key entries only once
Transactions are processed as and when they are entered
*Key concerns in Batch/Online Data Entry
Services must be performed within Length of Stay
Zero priced items are allowed
Quantity cannot be zero
In the event, services codes are not available. Miscellaneous codes may be used.
Mark up table is used, in the event the medical item used is new and service code has not been created. Miscellaneous charge code is employed, with price determined by a mark up table
Direct entry of services into billing system by billing staff
Difference between Charge Entry vs. Order Entry
is a service that has been performed and is pending data entry.
is a service that has not been performed but "ordered".
Closing the bill
Refers to instruction issued to the billing system to stop accepting services entries/ charge codes entries for an account. A service entered after a bill has been closed is termed a late charge.
For hospital billing, the bill has to be opened or cancelled if it has already been closed or billed, before any late charge can be entered.
Debit or credit note are not raised to manage late charges with regard to hospital billing.
Subvention & CCPS submission of claims will be compromised by the issuance of debit or credit notes
1. Item based package
A package defined by a list of items and quantity. (Similar to Macdonald set meal)
2. Dollar based package
A package defined by a price tag to treat a specific medical condition. It is usually further defined by list of exclusion. (Similar to a buffet meal)
Package covers all pregnancy-related consultations after your 20th week pregnancy.
It includes: -All clinic consultations with obstetricians from the 20th week of your pregnancy till the birth of your baby. - 2 ultrasound/ obstetric scans (at 22 and 32 weeks) to monitor the growth of your baby. - Up to 2 CTG sessions to monitor your baby's heartbeat and movements. - 1 postnatal consultation.
Deviation from Normal Pricing
Discount Service Codes
A service code that trigger a discount effect on the entire bill.
Surcharge Service Codes
a service code that trigger a surcharge effect on the entire bill.
a code that imposes a surcharge on certain services only. this code may be entered in the form a service code, payer code or a specially designed code.
Characteristics of a good charging process
Chapter 9 - Billing
Is defined as the generation of an invoice for the purpose of payment collection from a customer.
Consists of: Patient Information, Description of service rendered, Amount of the service, Total payable amount by 3rd party (if any), Total amount by patient.
Fee Cap Inpatient
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.
Traditional Method or 2 Individual Fee Caps (old practice)
Modern Approach or One Major Fee Cap / 3 in 1 (new practice)
Subsidy Cap for Implant
were introduced in 1993 for implants and prostheses
All class B2/C patients are given 50% subsidy for these items up to a maximum subsidy of $500 as long as the consultant-in-charge certifies that there is no other cheaper alternative suitable for the patient, irrespective of whether implant prosthesis is "standard" or "non-standard", except for cardiac devices.
To help subsidised patients as previously they would need to pay full cost for non-standard implants and prostheses.
GST impact for subsidised cases
was introduced in 1 April 1994
Subsidised patients are not required to pay the GST for their bill. These include inpatients (Class B2+/B2/C) surgery, and outpatients (SOC and polyclinic)
Unbilled Stage or Interim Bill
Refers to the period when the bill or invoice is open to addition of new charges.
Refersto the period when the bill or invoice is closed to addition of new charges but it is not yet ready for generation
When all services rendered has been keyed in the system. When the bill return to CPF board and is ready for generation.
Once the bill is finalised, an original bill will be printed and given to patient. In the event that patient request for extra copies of the bill, it will duplicate copies. Bill stamped with "Certified true copy" and acknowledge by the staff will be treated as original copy.
Cancelled Bill and Re-bill
Cancelled bill stage refers to the period when the bill or invoice is re-opened for addition of new charges.
If the patient has received a copy of the first bill, they must be advised of the re-bill via verbal or written means. The rebilled will be considered as a new bill to the patient as there are changes to the charges in the bill. An original invoice will be given for rebilling.
Chapter 10 - Counter Collection
Possible Payment modes
Cash, Cash card, credit cards, Ezlink card, paynow, wechat pay, alipay, grabpay, nets, cheque
Counter collection procedure is important as it ensures every cent collected is banked in to hospital account.
Fraud or negligence could be detected with counter collection mode.
It occurs when the actual collection in terms of cash and other modes is less than the amount stated in the system.
It is recorded and to be topped up on the same day and banked in together with the current day's collection.
Any excess cash collection should be banked-in together with the current day's collection.
Cashier/Collection staff should indicate on the counter discrepancies form the excess collection amount and an explanation resulting in the excess collection.
Credit Card Collection
Transactions: staff is required to print the Detailed & Batch Settlement Reports from the credit card terminals
Has to ensure that the sales slips are duly signed by cardholder and are collated according to the Detailed Report.
Cancellation of Receipt
Any cancellation of receipt must be properly recorded in the Cancellation of Receipt Form to be attached to the Close Counter Statement
Clinic/Location Manager will then verify before submitting to the Business Office.