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Financing in Healthcare (L10 (Possible Payment Modes at over-counter…

- - - - Documents for identification purposes e.g. NRIC, Work permit (if applicable)
      - Case type e.g. Outpatient
      - Visit Type e.g. First visit, follow-up visit
      - Referral Source e.g. Polyclinic, GP, self-referral
      - Payment Class e.g. SG, PR, FR, NR
      - Attending Service Provider
    - - Helps Singapore Civil Service to centrally manage and process the employee healthcare benefits
      - Secured web-based medical benefits and claims processing/pro-ration system
      - Integrated with healthcare providers, insurance companies and government agencies
      - Enable public service employees to enjoy medical benefits at clinics and hospital
    - - Payment is treated like money paid for services provided
      - Deposit deemed as money that may be refunded
      - Credit Assessment
        
        Rating A-F, Status, Payer, Follow-up Actions
      - Purpose of discharge summary
        
        Provide details of patient's medical condition
        
        Given to patient in case if employer or insurer needs medical information for processing of medical bills
      - Purpose of interim bill
        
        To collect any outstanding amount of cash before patient leaves the hospital
        
        Ensure patient is aware of his medical bill upon discharge
      - Duties
        
        Registration performed by PSA or PCA
        
        Front-line job includes managing patient's emotions
        
        Manage registration at counter
        
        Documentation done by Business Office Personnel
        
        Check and update Medisave and PMI Forms
        
        Back-end job
- - - - Components include Patient Information
      - Item Description
      - Quantity
      - Service Code
      - Acknowledgement of data entry completion
    - - Centralized Revenue Management Approach
      - Decentralized RMA
    - - Direct Entry of services into billing system by billing staff, uses charge forms
        
        Disadvantage includes human dependent, prone to error, subject to availability of staff to perform work as opposed to automated entry by system
      - Batch or Online Interface of services from ancillary medical to billing system
        
        online transactions are processed as and when they are entered
        
        Batch interface collect transactions over a period of time and process them all at once
        
        Benefits of Batch Interface
        
        Effective use of manpower, key entries only once
        
        Avoids idling computing resources
        
        Allows system to use different priorities for batch and interactive work
    - - Instruction issued to billing system to stop accepting service entries/charge code entries for an account
      - Service entered after a bill that has been closed is a late charge
    - - Comprehensive, robust, flexible, timely, accurate and compelete
    - - Discount Service Codes
      - Surcharge Service Codes
      - Conditional Codes
- - - - Clinic manager will verify and submit it to the business office
  - - - Close Counter Statement
      - Vendor Trust Receipts (White copy)
      - Detailed Reports (for credit card transactions)
      - Batch Settlement reports (for Credit card and NETS transactions)
      - Credit card sales and NETS slips
      - Any other supporting documentation eg . Refund Request Form,
      - Counter Discrepancies Form, Cancellation of Receipt Form / Payment Cancellation Report (if any ), Bill Cancellation Report
- - - - First Party Claim
      - Third Party Claim
        
        Civil Service
        
        MCPS
        
        MBS@Gov
        
        Private organisations (Letter of Guarantee)
        
        CPF
        
        Medisave
        
        Medishield Life
        
        Integrated Shield Plan
    - - claims are sent electronically via respective healthcare institution’s IT systems (LOGs are claimed manually)
      - Healthcare institutions will rectify and resubmit if error due to data entry If due to patient’s error (not covered by the specific 3rd party payer), the healthcare institution will charge to patient for payment
    - - Interim bill
        
        Bill of patients not finalized yet
        
        Charges are not confirmed or keyed in
        
        Allowed to make changes to the bill
      - Provisional bill
        
        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 form to the business office
        
        Amendment form to be approved by supervisor, business office-in-charge and higher authority if amount exceeds a certain limit
        
        Once Approved, staff may proceed with making the necessary adjustments, regenerate the bill and submit the claim
        
        Bill amendment is required when
        
        Changes to the services billed
        
        Changes to the visit information of a billed visit
    - - Denied claims
      - Rejected claims
      - Insufficient Information sent
      - Wrong Information sent
      - Non-claimable item sent
      - Double claims
      - Missing out on charging certain items
    - - Insufficient amount in account
      - Plan does not cover service used
      - Patient no longer eligible for 3rd party claims
      - Wrong date of birth entered
      - Wrong 3rd party payer
    - - Either sent by email or mail
- - - - Applied on surgical operations, lab tests, standard medications and X-rays
      - Ensure that subsidized patients would not be put to excessive difficulty to meet the revised hospital charges due to unnecessary tests/investigations
    - - Unbilled/Interim Stage - Bill is open to addition of new charges
      - Provisional Bill - Bill is closed to addition of new charges but not yet ready for generation
      - Final Bill - When all services rendered keyed into the system and when bill returns from CPF board it is ready to be generated
        
        Once bill is finalized, original bill will be printed and given to patient with a stamp of certified true copy
        
        For request of extra copies, it will be duplicate copies
    - - Rebilled is considered as a new bill as there are new changes to the charges in the bill, original invoice will be given
    - - All services billed at full rate as no subsidy is granted e.g. private class
      - Non-patient referred by external doctor to consume medical service offered by healthcare institution
      - If patient is subsidized at the referred institution, he will pay the amount less subsidy