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Summary of Healthcare (II) (Lesson 10 (Payment Modes for Hospital's…
Summary of Healthcare (II)
Lesson 7
Data needed during registration where billing errors could happen
Case type
Visit type
Supporting documents such as patient's details
referral source
Payment class (eg. SG citizen, PR citizen)
Attending service provider
Medical Claims Proration System (MCPS)
Integrated with healthcare providers to enable public service employees to enjoy medical benefits at clinic and hospitals
A secure web-based medical benefits and helps Singapore Civil Service to centrally manage and process employee healthcare benefits.
Registration of patient in SOC
Contact Number, 3rd Party payers,NOK information
Allergy information and referral source
Patient details such as Name, DOB,Address
Credit Assessment
There are different kinds of rating which is A to F
The different kind of ratings represents the level of credit assessment which is whether they are able to pay or not
The credit assessment also tells the payer what to do based on the patient's rating of A to F
It also tells the follow up actions based on their rating.
Ward Centric Collection
Advantage : located in the wards and able to detect visitors of patients
Disadvantage: Staff has to multitask the work and information involved in financial management
Tasked with monitoring the debt of patients
Patient Centric Collection
Have access to patient financial data and review the debt situation remotely
Advantages: centrally located and smaller team required .
Located in central location away from the patients
Disadvantage : Staff must proceed to wards to liase with patients and family members
Interim bill
To ensure patient is aware of his medical bill upon discharge as a final copy will not be presented immediately due to CCPS processing
To collect any cash outstanding before patient leaves the hospital
Lesson 8
Characteristics of Good Charging Process
Robust
Flexible
Comprehensive
Timely
Accurate
Complete
Charge form
Item Description
Quantity
Patient Details
Service code
Acknowledgement of Data entry completion
Charge Capture Process
Centralized Revenue Management
Responsible for the data entry work , eg: charge analyst
Sense of accountability is needed for appropriate charging
Data entry clerks are sited in an area where it is away from the services are performed
Higher cost due to the resource of charge analyst
Decentralized Revenue Management
A team of staff is responsible such as Doctors, Nurses ,PSA
Manpower need is lower as staff multitasks
Data entry clerks are sited in the wards where the services are performed
Multitasking cal lead to a delay charge
Lesson 9
Interim Bill
refers to the period when the bill or invoice is open to addition of new charges
Provisional Bill
When the bill or invoice is closed to addition of new charges but not ready yet for generation
Final bill
When all services rendered has been keyed in the system and when the bill returns from CPF board and is ready for generation
Once it is finalised, the original bill will be printed and given to patient
Cancelled Bill and Re-Bill
Cancelled bill is the period when the bill or invoice is re-opened for addition of new charges
Re-bill will be considered as a new bill to the patient as there are changes to the charges in the bill and an original invoice will be given for re billing.
Billing category
A categorization code used to group service code in a pricing catalogue
A bill Summary code
code that is used for purpose of presentation on a Summary Bill and does not display the individual items consumed for the period. The items must be grouped within a bill summary code.
Lesson 10
Payment Modes for Hospital's over-the-counter collections
Cash Card
Credit Cards (Visa/Mastercard etc)
Void sales slips must be submitted to Business Office
Leader must identify the patient's bill details and make an indication on the close counter if there is missing credit card slips
Total count and amount of approved sales slips must tally with Detailed and Batch Settlement Report
Nets
Total count and amount of NETS slips must tally with Batch Settlement Report
Ensure that the Nets slips are collated according to the Batch Settlement Report
Required to print The Batch Settlement Report from Nets Terminals
Void slips must be submitted to Business office
Leader must identify patient's bill details and make indication on close counter statement if there is any missing NETS slips
Cash
Cheque
Ez-link card
Shortages
Fraud or negligence could be detected with counter collection mode
Happens when actual collection in terms of cash and other modes is less that the actual amount stated in the system
When it happens, it is to be topped up on the same day and banked in together with the current day collection to tally with the amount stated
Any topping up is highlighted by the Business Office and separated from current day's collectioni
Staff may need to request pay by installment if the amount exceeds for eg. $100 and this must be approved by the Manager or executive
Excess
Any excess should be banked in together with current day's collection
Staff should indicate on the Counter Discrepancies Form the excess collection as well as the reason
Cancellation of Receipt
Any cancellation must be recorded in the cancellation of receipt form to be attached to the close counter statement
Clinic Manager will then verify before submitting to the Business office
Front-end Refund
A correct invoice and SAP refund form is required to be printed out for the patient to acknowledge the cash refund by signing it
SAP refund document to be enclosed with the daily close counter statement and send to Clinic Manager for verification and submission to Business Office
When there is over-charging or excess and a refund is due, staff may process an upfront cash refund if the customer requires the refund immediately
Back-end refund
If the customer has left the vicinity for the over-charging, the refund is initiated through refund request form.
Supervisor/Manager at the department must complete and sign the form before submitting to Business office
Handover confirmation
Closing Report includes :
Batch Settlement Report (for Credit Card and Nets Transactions)
Credit card Sales and NETS slips
Detailed Reports (for Credit Card Transactions)
Any other supporting documentation (eg. Refund Request Form, Counter Discrepancies Form, Cancellation of Receipt form if any)
Vendor Trust receipts (White Copy)
close counter statement
Cash Float
Kept in the cashier till or drawer throughout the transaction or cashier work session
cash given at the beginning of the day or session to provide change to be given to customers
May be handed over to the cashier working the next shift after a proper handover process
Lesson 12
Account types
Accounts Payable
General Ledger
Account Receivables
Profit and loss
Other Payment modes
Singpost Payment Counter
Cheers Payment Counter
SAM
Online
AXS
Internet Payment
Payment issues
Reconcilation issues : Payment may not tallied with outstanding amount
Delay in reflecting correct payment status : other payment modes may take longer time to clear and the billing system may not reflect the correct payment status
Refund
Refund may not be necessary be the full amount as it can be partial
There are various documents and processes required to process a refund to patient
Must be a credit balance in the account receivables in order for refund to be made
Investigations needs :
Medication refund note from pharmacy
Approval from supervisors and finance department
Refund voucher: reason for refund
Issues with refund
Monitoring required
Potential fraud
Limited mode of refund
Lesson 11
Common types of claims
Third Party claim: Patients may pay their medical bill through other agencies than themselves
Civil Service - Payment for employee medical benefits
Medical Billing system
Medical Claims Proration System (MCPS)
Private Organizations/ Insurance Companies
Letter of Guarantee (LOG)- Manual claim
CPF- Patient's own
CDMP
Medishield Life
Integrated shield plan
Medisave
First Party Claim : From patient directly
Claims Processing
Sent electrically through Healthcare Institution's IT system
Not all claims can be process successfully
Patients bill are sent to third payors
Healthcare institution will rectify and resubmit if there is any error due to data entry.
Bill amendment
Once approved by relevant authorities ,Staff may proceed to make necessary adjustments
Re-generate the bill and submit the claim
Required when there are changes to the visit information of a billed visit or changes to the services billed
Denied Claims
Refers to a claim that has been processed and insurer has found it to be not payable
Can usually be corrected and/or appealed for reconsideration
Rejected Claims
This happens when personal information is inaccurate like name, NRIC , NOK etc
A rejected claim cannot be appealed as it has not been processed and need to be researched, corrected and resubmitted.
Refers to a claim that has not been processed by insurer due to fatal error in the information provided
Reasons for claim rejection
Insufficient amount in account
Wrong information entered
Plan does not cover the service used
Wrong 3rd party payer
Patients no longer eligible for 3rd party claims
