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Financing for Healthcare (Counter Collection (Security feature of safe…

- - - - Data entry clerked sited away from where services are performed
      - Charge analyst is responsible for data entry work
      - Advantage: Sense of accountability for appropriate charging
      - Disadvantage: Possibility of higher cost due to resource of charge analyst
    - - Data entry clerks sited in wards/where services are performed
      - Team of staff responsible (e.g. doc, nurse, PSA)
      - Advantage: Manpower is lower through multitasking of staff
      - Disadvantage: Daily charge reconciliation often delayed/not performed as clinical staff may not understand the revenue aspect
  - - - Online interface: Transaction processed as and when they are entered
      - Batch Interface: Collect transaction over a period of time then process all at once
        
        Shift time of job processing to when computing resources are less busy
        
        Avoids idling computing resource
        
        Amortizes the IT system through high rate of utilisaiton
        
        Allows system to use different priorities
        
        Allows effective use of manpower, key entries once
      - Concerns
        
        Quantity cannot be 0
        
        Services must be performed within length of stay
        
        0 priced items are allowed
        
        Miscellaneous codes may be used
- - - - e.g. First visit, Follow-up visit
    - - e.g. Polyclinic, GP, Self-referral
    - - e.g. Outpatient
    - - e.g. SC, PR, FR, NR
      - To determine the patient class:
        
        Polyclinic, A&E in public hosp, Public SOCs, Public hospital
    - - e.g. NRIC, Work Permit
  - - - Enabling public service employee to enjoy medical benefits at clinics and hospitals
  - - - Money paid for services rendered
    - - Monies that may be refunded
    - - A: SG (PTE/SUB)
        
        MCPS Copayment ward scheme
        
        Premier private integrated plan insurance scheme (w rider)
        
        Must signed Letter of Undertaking
      - B: SG (SUB)
        
        Public/similar assistance card
        
        CPF related insurance scheme & Medisave min balance: $3,000
        
        Min cash deposit:$3,000/as per bill size
        
        Sufficient 3rd party coverage
        
        Must signed Letter of Undertaking
      - C: SG (PTE) & PR (PTE/SUB)
        
        CPF related insurance scheme & Medisave min balance: $6,000
        
        Min cash deposit: $10,000/as per bill size
        
        Sufficient 3rd party coverage
        
        Must signed Letter of Undertaking
      - D: NR, FR
        
        Min cash deposit: $10,000 or as per bill size
        
        Sufficient 3rd party coverage
        
        Employer is credit worthy with Letter of Understanding (must signed)
      - E
        
        Unable to establish patient identity or citizenship status
        
        Sourcing for 3rd party coverage
      - F
        
        Confirmed specific bad debtor
- - - - Traditional method or 3 individual fee cap
      - Modern approach or one major fee cap/3 in 1
  - - - B2+/B2/C, day surgery, outpatient (SOC & polyclinic)
- - - - Tamper evident bag no
      - Amount contained in bag
      - Name of staff depositing the bag
      - Signature of witness
- - - - Civil service
        
        Medical Claims Proration System (MCPS): gov restructured hosp, SOCs, polyclinic
        
        Medical billing system or MBS@Gov: GPs & Dialysis centre
      - Private organisation/employers/insurance companies (Letter of guarantee)
      - CPF - patient's own
        
        Medisave
        
        Medishield Life
        
        Integrated Shield Plan (IP)
  - - - Supervisor-in-charge
      - Business office in-charge
      - Higher authority if amt exceeds a certain limit
    - - Changes to the visit info of a billed visit
      - Changes to services billed
  - - - Heath Level Seven (HL7): Standard for exchanging info between medical application
  - - - Has been processed and insurer found it not payable
      - Can be corrected/appealed for reconsideration
    - - Has not been processed by insurer due to fatal error in info provided
  - - - Pros: patient will be the one chasing HR instead
- - - - Pros: Quick & easy, transactions are completed immediately, cash can be used for next transaction
      - Cons: Physically counting and tallying of amount required, may be stolen
    - - Transaction made electronically, secured payment
      - Unable to revert transaction once approved, only can refund via cash/cheque, processing fee
    - - Pros:Guarantee payment, allow payment by installment plan, rectification if any error
      - Cons: Possibility of fraud
    - - Pros: payee need not be present to make payment
      - Cons: takes time to process, payment be rejected if any error or insufficient fund
  - - - Return of medication
      - Service paid but not performed
      - Lapse in service provided
      - Over-charge of service rendered
      - Deposit balance from surgery
      - Duplicate payment
    - - Limited mode of refund
      - Monitoring required
      - Potential fraud
  - - - Bank reconciliation
      - Refund can be processed directly from bank
      - Payment posting outsourced to other financing companies
      - Debt recovery
      - 3rd party billing
    - - External parties may not have proper understandings of business process
      - 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
  - - - From management side, identify probs w receivables management process
      - From operational side, identify accounts that require collection action