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Financing for Healthcare (Nur Shaqilah Binte Sulaiman) (PART 2)…

- - - - Front-end
        -SAP refund document is to be enclosed with the daily Close Counter Statement and send to Clinic/ Location Manager for verification and submission to the Business Office.
        
        Over-charging or collection more than bill amount and refund is due: staff may process upfront cash refund if the customer requires the refund immediately.
        
        Correct invoice and SAP refund form is required to be printed out for patients to acknowledge the cash refund by signing the SAP refund form
      - Back-end
        
        Refunds arising from over-charging of patient at the countries after customer has left vicinity of the healthcare institution, refund is iniated through the Refund Request Form
        
        Supervisor/ Executive/ Manager in charge at the respective department must complete and sign the form before submitting to Business Office.
    - - Credit Card
        
        Staff is required to print the Detailed and Batch Settlement from the credit card terminals
        
        Supervisor/ Leader has to ensure that the sales slips are duty signed by cardholder and are collected according to the Detailed Report
        
        Total count and amount of approved sales slips must tally to both the Detailed and Batch Settlement Report.
        
        Void sales slips must be submitted to Business Office
        
        In the event of missing credit card slips, Supervisor/Leader must identity the patient bill details and make an indication on the Close Counter Statement
      - NETS
        
        Staff are required to print Batch Settlement Report from the NETS terminals.
        
        Supervisor/ Leader has to be ensure that the NETS slips are collated according to the Batch Settlement Report.
        
        Total count and amount of slips must tally with the Batch Settlement Report. Void slips must be submitted to Business Office
        
        If missing NETS slips, Supervisor/ Leader must identity the patients' bill details and make an indication on the close Counter Statement
    - - Handover Reports
        
        Business Office Assistant need to tally the Handover Confirmation Report to the Vendor Trust Receipts and the amount credited to the bank account on a daily basis for cash payment
        
        Also tally it with the bank statements of Credit cards and NETS transactions
        
        Have discrepancy in the Handover Confirmation Reports: Assistant will verify discrepancy against Close Counter Statement (after verify: adjustments posted in SAP system to clear off discrepancy)
        
        Shortage recorded: Assistant approach cashier staff to top-up amount
        
        Some place requires top-up for shortages more than a specific amount
      - Bank
        
        Amount in the handover confirmation report tallies with amout credited in bank: Business Office Assistant performs clearing to the Main Bank account on a regular basis
        
        Business Office Assistant prepare Bank Reconciliation monthly (reviewed by Supervisor and Executive)
        
        Copy of it will be forwarded to the Finance Department for their retention.
    - - Supervisor/Leader shall perform Handover function by generating the Handover Confirmation Report from Billing System on a daily basis
        
        Reconcile the Counter Summary Report Statements to the Handover Confirmation Report(ensure that all discrepancies are clearly explained and adjusted where necessary)
        
        Consolidated report indicating all counters that were opened for transactions (supervisors are able to detect unauthorised counter that were opened for transactions and discrepancies for the day)
        
        Supervisors need to sign the report and retain a photocopy for department filling (5 years) before submitting the original set to business Office on the next working day
      - Complete set of closing reports would include:
        
        Close counter statement
        
        Vendor trust receipts (white copy)
        
        Detailed reports (credit card transactions)
        
        Batch settlements reports (credit card and NETS transactions)
        
        Credit card sales and NETS slips
        
        Any other supporting documentation (refund request for, counter discrepancies form, cancellation of receipt form)
      - Handling of Physical Cash and Completion of Vendor's Trust Receipts
        
        Staff is require to write clearly on the serialized Vendor Trust Receipt the amount of cash and check contained inside each tamper evident bad and duly initial on it.
        
        Vendor Trust Receipt comes in 3-ply and the distribution is as follow:
        a.) 1st copy (white) is submitted to Business Office
        b.) 2nd copy (pink) is submitted to Vendor
        c.) 3rd copy (blue) is retained in the Trust Receipt book
        
        Cheque deposits
        
        Cashier/Collection staff is required to prepare the Bank in Slip. Cashier/Collection staff may enclose the cheques and the bank-in slip with the cash collected in the same serialized vendor tamper evident.
        
        The check amount and total amount of cash must be written on the tamper evident bag
        
        All required information (Staff name, Vendor tamper evident bag number, etc) must be clearly stated.
        
        It is good practice to sign off when handling over cash. It is recommended to have 2 staff when counting cash.
      - Deposit of Cash at Designated points
        
        Collections are to b deposited at designated safe locations within the Hospital
        
        A record book is maintained at the safe premise ad eh following information is required be recorded:
        a.) Tamper Evident Bag No
        b.) Amount contained in bag
        c.) Name of staff depositing the bag
        d.) Signature of witness.
  - - - Unbilled Stage or Interim Bill
        
        The period when the bill or invoice is open to audition of new charges
        
        On going bill
      - Provisional Bill
        
        The period when the bill or invoice is closed to addition of new charges but it is not ready yet for generation.
        
        In Singapore, bill/invoice is submitted via Central Claim Processing System (CCPS) for claiming against Medisave, Medshield Life and Private Medical Insurance
      - Final Bill
        
        When all services rendered has been keyed in the system.
        
        When the bill returns from CPF board and is ready for generation
        
        Original/Duplicate
        
        Once the bill is finalised, an original bill will be printed and given to patient. The bill would be stamped as "Certified true copy"
        
        Requesting for an extra copies of the bill is known as a duplicate copies.
      - Cancelled Bill and Re-bill
        - Cancelled bill is the period when the bill or invoice is re-opened for addition of new charges
        (If patient has received a copy of the first bill, they must be advised of the re-bill via verbal or written means)
        
        - Rebilled is considered as a new bill to the patient as there are changes to the charges in the bill.
  - - - Centralized Revenue Management
        
        Data entry clerks are sited in an area away from where the services are performed
        
        A single staff is responsible for the data entry work (Charge Analyst)
        
        -Advantage: Sense of accountability for appropriate charging from the Charge Analyst
        - Disadvantage: Possibility of higher cost due to the resource of a Charge Analyst.
      - Decentralized Revenue Management Approach
        
        Data entry clerks are sited in the wards or where the services are performed
        
        A team of staff is responsible
        
        - Advantage: Manpower need is lower through multitasking of staff.
        - 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.
    - - Direct Entry of service into billing system by billing staff (use of charge forms)
      - Batch/ Online Interface of services from ancillary medical system to billing system (entry of service items by the various service stations)
        
        Batch Interface is used to collect transactions over a period of time and then process all of the transaction at once
        
        It can shift the time of job processing to when the computing resources are less busy.
        
        It avoids idling the computing resources with minute-by-minute manual intervention and supervision.
        
        By keeping high overall rate of utilization, it amortizes the IT system
        
        It allows the system to use different priorities for batch and interactive work also allow effective use of manpower.
- - - - a.) Civil Service
        (Payment for employee medical benefits)
        
        Medical Claim Proration System (MCPS)- Government restructured hospitals, SOCs and Polyclinics
        
        Medical Billing System or MBS@GOV- GPs and Dialysis Centres
      - b.) Private organisation/ employers/ insurance companies of the patients (Letter of Guarantee- Manual claim)
      - c.) CPF Board- Central Claim Processing System (CCPS)/ Mediclaim System
        
        Medisave
        
        Medishield Life
        
        Integrated Shield Plan (IP)
  - - - Advantage
        
        Payments are guaranteed (CCPS, MCPS, LOG) unless patient is no longer entitled or covered
        
        Direct credits to institution accounts
      - Disadvantage
        
        Longer processing time
        
        Difficult for staff to keep track of the different schemes available
        
        System update needed for any changes to the schemes.
    - - Advantage
        
        Need not pay up front
        
        Co-payment by the organization they belong to.
      - Disadvantage
        
        Does not cover all medical expenses.
  - - - Unbilled/ Interim Bill
        
        The stage when the bill of the patients is not finalized.
        
        Charges are not confirmed or keyed in.
        
        Changes to bill is possible.
      - Provisional Bill
        
        When charges are confirmed and sent for claims
        
        Changes to bill not allowed.
      - Final Bill
        
        Claims processed
        
        Any changes to bill will have to raise bill amendment
    - - Staff will raise a bill amendment from the business office
      - Needs to be approved by relevant parties:
        
        Supervisor in-charge
        -Business office in-charge
        
        Higher authority if amount exceeds a certain limit.
      - Once approved: Staff proceed to make necessary adjustments
      - Re-generate the bill and submit the claim.
      - Needed when:
        
        Changes to the visit information of a billed visit (Wrong source of referral, wrong 3rd party payer)
        
        Changes too the services billed (over or under billed of services
      - Flow Process:
        
        Identifies the bills to be amended and raise amendment form
        
        Seek approval by supervisor
        
        Business Office check and seek approval
        
        Approved by business Manager/ CFO (For large amounts)
        
        Physical amendment form to be filled and audit purpose.
  - - - Plan does not cover the services used
        
        Cosmetic surgery
      - Insufficient amount in account
        
        Claim amount exceeds entitlement
        
        Claim amount exceeds balance (Medisave)
      - Wrong date of birth entered (new requirement by CPF for verification)
      - Wrong 3rd party payer
        
        Selected MCPS instead of CCPS
      - Patient no longer eligible for 3rd party claims
        
        No longer a civil servant
        
        No longer covered by the insurance.
    - - Business office staff need to amend claim message and resubmit
      - Make necessary adjustments to the bill (cancel provision (open)-- amend details-- rebill (provision))
      - If patient no longer covered by 3rd party payer, send outstanding bill o patient for payment by other mode (AXS, Cheques0
- - - - May not be necessary be the full amount (sometimes can be partial)
        
        Must have credit balance in the Accounts Receivable refund to be made.
        
        Various Scenarios:
        
        Return of medications (some institutions do not allow
        
        Service paid but not performed
        
        Lapse in service provided (wrong diagnosis or wrong result)
        
        Over charge of service rendered
        
        Deposit balance from surgery
        
        Duplicate payments (patient paid twice or 3rd party and patient paid for same service)
    - - Various documents and processes required before processing refund to patient
        
        Refund voucher (State reason for refund-- duplicate charges, using patient bill as supporting documents)
        
        Medication refund note from pharmacy
        
        Approval from supervisor and finance department
    - - Limited mode of refund; mostly by cheque to cross day refund.
        
        Monitoring required; staff need to monitor different stages of refund (refund approved, cheque issued, system updated, cheques cleared)
        
        Potential Fraud: Cheque being issued to the correct payee, patient may claim that they did not receive the refund.
  - - - Report
        
        Report showing services that is rendered and payment not collected
        
        Managerial perspective; identity problems with receivables management process.
        
        Operational perspective; identity accounts that require collection action.
      - Working on AR
        
        Common use; collecting overdue balances from 3rd party payers and patients
        
        Reports should be stratified by; payer (patient balance vs insurance balance), age (patient balances over 90 days), balance amount (within a category, list accounts in descending order of balance owed)
        
        Staff should work on the largest accounts first when making the collection effort to patients.
        
        Determine the minimum level of small balance write-offs.
      - Avoiding
        
        The most effective way of reducing your AR is to collect charges at the time of service.
        All payment should be collected at the time of registration, before the physician sees the patient.
- - - - Payment is treated as money paid for service rendered
        
        Deposit is deemed to be monies that my be refunded.
    - - Ward Centric Collection
        
        PSA or ward clerks are tasked with monitoring the debt of patients
        
        - Advantage: Staff are located in the wards and is able to detect visitors or patients
        - Disadvantage: Staff has to multi-task, the work and information involved in financial management is intensive
      - Patient Centric Collection
        
        A team of PSA is located in a central location away from patient. They have access to patient financial data and review the debt situation remotely.
        
        - Advantage: Staff are centrally located and smaller team is required. Intensive training and information is readily offered
        - Disadvantage: Staff must proceed to the wards to liaise with patients and family members