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Financing For Health (P11: Claims Processing (Bill Amendment Flow…

- - - - Civil Service
      - Private Organisation / Employers
      - CPF (Patient's own)
  - - - Denied claims
      - Rejected Claims
  - - - Must be approved by supervisor in-charge
        
        Business office in-charge
        
        Higher authority if amount exceeds a certain limit
- - - - Money owed to a healthcare institution by any 3rd party payor and patients
      - If outstanding bills not paid within specific period will be term as bad debts
      - Will identify problems with your receivables management process
      - Report should be stratified by the payer, age and in descending order of balance owed
    - - Reconciliation Issue
      - Delay in reflecting correct payment status
  - - - Limited mode of refund
      - Monitoring Required
      - Potential Fraud
  - - - External party may not have proper understandings of business process of institution
      - Any rectification required by institution may take longer time
      - Decision to outsource may come from cluster and not necessary cost effective for all institution involved
- - - - Ward Centric Collection
    - - Team of PSA located in central location away from patient.
        
        Have access to patient financial data and review debt situation remotely
    - - Summary provides details of patient medical condition
        
        Given to patient in event that Employer or Insurer needs medical information for processing of medical bills
- - - - Data entry sited in wards or where services are performed
      - Team of staff is responsible e.g. Doctors, Nurses, PSA
      - Advantage: Manpower need is lower through multitasking of staff
      - Disadvantage: Daily charge reconciliation is often elayed / not performed at all as clinical staff may not understand the revenue
    - - Data entry clerks sited in an area far away from services are performed
      - Single staff is responsible for data entry at work
      - Advantage: Sense of accountability for appropriate charging from the Charge Analyst
      - Disadvantage: Possibility of higher cost due to resource of Charge Analyst
    - - Direct entry of services into billing system via billing staff (usage of charge forms)
      - Batch/Online interface of services from ancillary medical system to billing system
      - Late Charge
        
        Bill has to be opened or cancelled
        
        Item based package: by list of items and quantity
        
        Dollar Based Package: By price tag
- - - - Help subsidised patients as previously they would need to pay full cost for non-standard implants and prostheses
- - - - Arising from over-charging of patient at counters after customer has left the vicinity
      - Supervisor/Executive/ Manager in charge must complete and sign the form before submitting to Business Office