# data[].attributes.body
• The most common use of the AR report is for collecting overdue balances from both 3rd party payers and patients.
• The report should be stratified by:
- The payer (by patient balance vs. insurance balance vs Medisave vs. Other Third Parties),
• age of the outstanding amount (e.g ., patient balances
over 30, 60, 90 and 120 days),
• balance amount (e.g., 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

# data[].attributes.body
Accounts Receivable Report is a report that shows
services that is rendered and payment not collected
• From a management perspective, the AR reports will
identify problems with your receivables management
process
• From an operational perspective, the AR reports
identify accounts that require collection action

# data[].attributes.body
- AR or accounts receivable is the money owed to a
healthcare institution by any 3 rd party payor and
patients After a service is rendered to a patient, a bill
is sent to the respective 3 rd party payer or patient
requesting payment This outstanding bill is
accounts receivable

- If these outstanding bills are not paid within a specific
period, they will be term as bad debts

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• External parties may not have proper understandings
of the business process of the institution
• Any rectification required by the institution may take
longer time
• Decision to outsource may come from cluster and not
necessary cost effective for all the institutions involved ..(e g NHG and SingHealth cluster consolidate some of the financial and human resource services)

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• Institutions may choose to outsource some of their business functions to another party For public healthcare like NHG and SingHealth certain business functions are consolidated to Finance Shared Services (FSS) which processes for institutions under the same cluster For example
• Bank reconciliation (depends on institution)
• Refund can be processed directly from the bank
• Payment posting outsourced to other financing companies
• Debt recovery
• 3 rd Party Billing billing of other organisations

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• When the amount in the Handover Confirmation Report tallies to the amount credited to the bank, Business Office Assistant will perform clearing to the Main Bank account on a regular basis
• Business Office Assistant will prepare the Bank
Reconciliation monthly to be reviewed by the Supervisor and Executive
• A copy of the Bank Reconciliation will be forwarded to the Finance Department for their retention

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There are various documents and processes
required prior to processing a refund to a patient

- Investigation on whether a genuine refund is required
- Supporting documents
• Refund voucher Stating the reason for refund ..(e g duplicate charges, using patient bill as supporting
documents)
• Medication refund note from the pharmacy
• Approval from supervisors and finance department
• Return the money (front end refund) or issue a cheque bank transfer (back end refund)
• Attach all supporting documents

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There must be a credit balance in the Accounts
Receivables in order for refund to be made

- There are various scenario where a refund is required
- Return of medications  (some institutions do not allow return of medications)
- Service paid but not performed
- Lapse in service provided ..(e g wrong diagnosis or wrong result)
- Over charge of service rendered
- Deposit balance from surgery
- Duplicate payments ..(e g patient paid twice or 3rd party and patient paid for same service

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Network for Electronic Transfers (NETS)  Pte Ltd or NETS was founded in 1985 and is owned by DBS Bank, OCBC Bank and UOB Bank It is designated by the Monetary Authority of Singapore to be Singapore’s national PIN Debit payment system.

NETS is the scheme operator, processor and acquirer
of the services

The NETS EFTPOS (Electronic Funds Transfer at
Point of Sale) catapulted Singapore into the age of
electronic payment It enabled bank customers to
make purchases through point of sales payment
using their ATM cards

CashCard is a stored value smart card used widely
in the motoring market in Singapore

FlashPay Card which is used for public transport
payments and at NETS acceptance points in
Singapore

eNETS online payment through online and mobile
merchants

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Other payment modes that patient can use

# data[].attributes.subject
Other payment modes that patient can use

# data[].attributes.body
• AXS
• SAM
• Singpost Payment Counter
• Cheers Payment Counter
• Online
• Internet payment

# data[].attributes.body
• AR Accounts Receivable
- Money owed by patients (individuals or corporations) to another entity in exchange for goods or services that have been delivered or used, but not yet paid for

AP Accounts Payable

- Debts that must be paid off to another entity (for example vendors, medical equipment suppliers or pharmaceutical companies) within a given period of time in order to avoid default At the corporate level, AP refers to short term debt
payments to suppliers and banks

GL General Ledger.
• A general ledger is a complete record of financial transactions over the life of a company . The ledger holds account information that is needed to prepare financial statements, and includes accounts for assets, liabilities, owners' equity, revenues and expenses

• P&L Profit & Loss
• A financial statement that summarizes the revenues, costs and expenses incurred during a specific period of time usually a fiscal quarter or year. These records provide information that shows the ability of a company to generate profit by increasing revenue and reducing costs.

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Off site payment, refunds and outstanding payment

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1.  Insufficient Information Sent
2. Wrong information sent
3. Non claimable item sent
4. Missing out on charging certain items
5. Bill exceeded claimable amount
6. Patients no longer eligible for 3rd party

# data[].attributes.body
- A denied claim refers to a claim that has been
processed and the insurer has found it to be not
payable
= A rejected claim refers to a claim that has not been
processed by the insurer due to a fatal error in the
information provided

# data[].attributes.body
• Claim message is send via the internet to the respective claim parties using HL7 messages
• Health Level Seven (HL7) is a standard for exchanging information between medical applications
• A HL7 message is generated with the necessary information once the patients is being billed
• Depending on the institution’s requirement, these
message are processed real time or by batches

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-  Bill amendment is required when
• There are changes to the visit information of a billed visit Example wrong source of referral (Polyclinic instead of GP), wrong 3rd party payer
• There are changes to the services billed
Example Over or under billed of services

# data[].attributes.body
• In the event when the bill needs to be amended, the staff ( nursing and other departments) will raise a bill
amendment form to the business office
• Amendment form needs to be approved by the relevant parties
• Supervisor in charge
• Business office in charge
• Higher authority if amount exceeds a certain limit

• Once approved by the relevant authorities, staff may proceed to make the necessary adjustments
• Re generate the bill and submit the claim

# data[].attributes.body
Patients bills are sent to the respective agencies for payment

• Usually such claims are sent electronically via respective
healthcare institution’s IT systems. (LOGs are claimed
manually)
• Not all claims can be process successfully due to various
reasons
• 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

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a) Civil Service payment for employee medical benefits
i. Medical Claims Proration System (MCPS) -
Government restructured hospitals, SOCs and
Polyclinics
ii. Medical Billing System or MBS@Gov - GPs and Dialysis Centres
b) Private organizations/employers/insurance companies of the patients (Letter Of Guarantee - Manual claim)
c) CPF Board Central Claim Processing System
(CCPS) / Mediclaim System
i. Medisave
ii. Medishield Life
iii. Intergrated Shield Plan (IP)

# data[].attributes.body
1. ‘First party claim’ from patient directly
2. Third party claim Patients may pay their medical bills through other agencies other than by themselves common third party payors
a) Civil Service payment for employee medical benefits (Government officers, pensioners and their dependants)
b) Private organizations/employers/insurance companies of the patients (Letter Of Guarantee)
c) CPF Patients’ own
i. Medisave for hospital bills or for Chronic Disease Management Programme (CDMP)
ii. Medishield Life
iii. Integrated Shield Plan

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Claims Processing

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• There are occasions where patients will leave the
healthcare institutions after receiving the services or
medications without payment This is known as a “walk off”
• These should not be confused with “No Shows” which refers to patients which have been scheduled for consultation but did not come
• Where possible, the workflow will make the patient pay for the services medication first E g Polyclinic makes the patients pay for medications before they can get a referral to the hospital specialist clinic, TTSH SOC clinics collect payment for medication at the clinic before the patient is sent to collect the medication at the pharmacy
• It is made worse that patients may visit different
departments before their journey ends, e g go to
Diagnostic Radiology Department to take X Ray before going back to the clinic to see the doctor If the patients leaves after taking the X Ray without paying for it, resources would have been used without receiving payment
• It would be more difficult and will cost more resources to collect payment after the services, product, medication is provided to the patient
• Special attention is therefor paid to reduce prevent
“walk offs” because they represent uncollected debts
which can potentially result in bad debts and loss to the organization

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• Cash float is the cash given to cashier at the beginning of the day or session to provide change to be given to
customers
• Cash float is kept in the cashier till or drawer throughout the transaction or cashier work session
• Different amount in different denomination must be distributed to each cashier at the start of the session
• The cash float may be handed over to the cashier working the next shift after a proper handover process
• However, for ease of management, each staff should be given their personal float to administer The amount may range from 100 to
800 sporadic spot check must be conducted to ensure the float is intact
• At the end of the day or cashier session, the department cash float should be deposited into a different safe from the counter cash
collections safe

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Back End Refund

- For refunds arising from over charging of patient at the counters after the customer has left the vicinity of the healthcare institution, the refund is initiated 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 .

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Front End Refund

- In the event where there is over charging or collection more than bill amount (excess) and a refund is due, Cashier/Collection staff may process an upfront cash refund if the customer requires the refund immediately

- A correct invoice and SAP refund form is required to be printed out for the patient to acknowledge the cash refund by signing on the SAP refund form.

- The 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.

# data[].attributes.body
- Any cancellation of receipt must be properly
recorded in the Cancellation of Receipt Form to be attached to the Close Counter Statement

- Clinic/Location Manager will then verify before submitting to the Business Office.

# data[].attributes.body
• For NETS transactions, Cashier/Collection staff is required to print the Batch Settlement Report from the NETS terminals
• Supervisor/Leader has to ensure that the NETS slips are collated according to the Batch Settlement Report
• The total count and amount of NETS slips must tally with the Batch Settlement Report Void NETS slips must be submitted to Business Office
• In the event of missing NETS slips, Supervisor/Leader must identify the patient’s bill details and make an indication on the
Close Counter Statement

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• For credit card transactions, Cashier/Collection staff is required to print the Detailed and Batch
Settlement Reports from the credit card terminals
• Supervisor/Leader has to ensure that the sales slips
are duly signed by cardholder and are collated
according to the Detailed Report
• The 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 identify the patient’s bill
details and make an indication on the Close Counter
Statement

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- Any excess cash collection should be banked in together with the current day’s collection

- Cashier/Collection staff should indicate on the Counter Discrepancies Form the excess collection amount and an explanation resulting in the excess collection

# data[].attributes.body
Shortages
= Counter collection procedure is important as it ensures every cent collected is banked in to the hospital account.
- Fraud or negligence could be detected with counter collection mode.
- A shortage happens when the actual collection in terms of cash and other modes is less than the amount stated in the system.
- Where a shortage is recorded, the shortage is to be topped up on the same day and banked in together with the current day’s collection.
- Any topping up of cash shortages for amounts
highlighted by Business Office should be separated
from current day’s collection
- The cash top up must be handed over to Business
Office staff for bank in
- For material shortages exceeding a high amount
(e g 100 00 the Cashier/Collection staff may
request to pay by installment, Manager in charge
should seek approval from the Business Office
Manager or Executive

# data[].attributes.body
- An option is to permit patients to depart from the clinic without billing patient
- A bill will be generated when the billing system is returned to
normalcy
- While downtime billing may ensure payment is collected, the
manual process will extend payment and queue time.  For
subsidized patients the GST must be absorbed, hence billing
staff must ensure the right prices is selected for computation
- Pricing catalogue must indicate both GST inclusive and exclusive prices for ease of computation
Downtime billing is only applicable for outpatient setting and collection in advance and deposits

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- Cash
- NETS
- Cash card Cheque
- Credit cards (e.g. Visa/ Master card, Diners Card,
Amex Card, JCB Card)
- Ez link Card
= GrabPay
- PayNow
- Alipay
- WeChat Pay

# data[].attributes.body
- Work involved in ensuring all collections (via means of cash, cheques, Network for Electronic Transfers , Credit Card, EzLink etc ) transacted at the counters are accounted for.
- All collections are deposited in the designated bank accounts
of the healthcare institutions
- To ensure reconciliation and timely detection of discrepancies cashier or collection staff must ensure that Close Counter is performed after the day’s shift and the total collections received reconcile to the amounts in the Close Counter Statements

# data[].attributes.body
A non patient is a customer referred by an
external doctor to consume medical service
offered by the healthcare institution
For example, a polyclinic doctor may refer a
patient to a hospital for MRI or CT Scan as the
polyclinic has no MRI or CT Scan machines
Patient is referred to the diagnostic imaging dept of the hospital and not the specialist of the hospital The results are interpreted and sent to the referring polyclinic doctors

All services must be billed at Full rate since no
subsidy is granted
If patient is subsidized at the referring institution, he or she will just have to pay the amount less subsidy The subsidy amount must be billed to the referring institution that is subvented by MOH
If patient is a private class, he or she will have to pay the full rate

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Counter Collection

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A&E facilities are meant for patients with emergency conditions
Subsidies are accorded to all emergency patients regardless of their citizenship and/or residential status of the patient
The subsidy rate is set at 50%  of the norm cost of treating an emergency case
The other 50% are to be recovered from patient’s charges

A&E fee is a single flat fee system applying to
both emergency and non emergency patients
The cost of treating an emergency case is far
higher than that of a non emergency case
Since the amount to pay is much higher, a
patient with a minor ailment should be deterred from clogging up A&E departments This is applicable only to cash paying customers

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Information that can be found on the receipt portion of the bill 

# data[].attributes.subject
Information that can be found on the receipt portion of the bill 

# data[].attributes.body
The receipt component includes:

1. Payer Name
2. Bill amount
3. Payment amount
4. Adjustment amount
5. Amount due

It is important to display the information in one document for the purpose of medical employment benefits and insurance claim.

# data[].attributes.body
A Bill cum Receipt displays the services consumed and the payment details as well. A typical hospital bill usually display both the billing and payment details on the same page.

# data[].attributes.body
A Service Code is a unique code that describes the services or item with a price.

Billing staff enters a service into the billing system to post a charge.

Example of a service code

Service Code: CXR002L

Description: Chest X Ray Left Side

Full Price: $45

B1 Price: $40

B2 Price: $24

C Price : $15

# data[].attributes.body
A Billing Category is a categorization code used to group service code in a pricing catalogue.

A Bill Summary Code is a code that is used for purpose of presentation on a Summary Bill. A summary bill does not display the individual items consumed for a particular episode. The items must be grouped within a bill summary code.

# data[].attributes.body
The cancelled bill stage refers to 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

The rebilled will be considered as a new bill to the
patient as there are changes to the charges in the bill
An original invoice will be given for rebilling

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CareShield Life will provide better protection and assurance in 4 ways:

1  Lifetime cash payouts - For as long as you are severely disabled

2  Payouts increase over time

Starting at $600 per month in 2020
Payouts increase until age 67, or when you make
claims, whichever is earlier

3 Government Subsidies to make it affordable - No one will lose coverage if they cannot pay the
premiums.

4 Premiums can be fully payable by MediSave

# data[].attributes.body
To provide more support to the ageing population, CareShield Life will replace Eldershield in 2020,
CareShield Life will feature higher payouts that  increase over time with no cap on payout duration, to provide better protection against the uncertainty of long term care costs if you become severely disabled

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There are 3 medical benefit schemes:

Comprehensive Co-Payment Scheme (CCS)
- For Civil Servants appointed BEFORE 1 Jan 1994

Medisave-cum-Subsidised Outpatient Scheme (MSO)
- - For Civil Servants appointed FROM 1 Jan 2994

Co-Payament on Ward Charges Scheme

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Types of Bills in a RESTRUCTURED hospital

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Types of Bills in a RESTRUCTURED hospital

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1. The Unbilled or Interim Bill stage refers to the period when the bill or invoice is open to addition of new charges. (OPEN BILL)

2. The Provisional Bill stage refers to the period when the bill or invoice is closed to addition of new charges but it is not yet ready for generation.  In the Singapore context, the bill or invoice is submitted via CCPS or Central Claim Processing System for claiming against Medisave, Medishield Life and Private Medical Insurance. (CLOSED BILL)

3. The Final Bill is when all services rendered has been keyed in the system When the bill returns from CPF board and is ready for generation

Once the bill is finalised , an original bill will be printed and given to patient. In the event that patient request for extra copies of the bill, it will be duplicate copies. Bill stamped with “Certified true copy” and acknowledge by the staff will be treated as original copy.

The cancelled bill stage refers to the period when the bill or invoice is re opened for addition of new charge. If patient has received a copy of the first bill, they must be advised of the re bill via verbal or written means The rebilled will be considered as a new bill to the patient as there are changes to the charges in the bill

An original invoice will be given for rebilling

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- The Goods and Services Tax (GST)  was introduced on 1
Apr 1994
- Subsidised patients are not required to pay the GST for
their bill These include inpatients (Class B2+/B2/ day
surgery,  and outpatients (SOC and polyclinic)
- The funding of GST absorbed by the government
healthcare institutions for these subsidized patients is
provided by MOH.

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Subsidy caps were introduced in 1993 for implants and prostheses

All Class B2/C patients are given a 50 subsidy for these items up to a maximum subsidy of 500 as long as the consultant in charge certifies that there is no other cheaper alternative suitable for the patient, irrespective of whether the implant/prosthesis is “or “non standard”, except for cardiac devices

This is meant to help subsidized patients as previously they would need to pay full cost for non standard implants and prostheses

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1. Traditional Method or 3 Individual Fee Caps (old
practice)
i. Laboratory tests : $80
ii. Specialized investigations: $80
iii. X rays : $80

2. Modern Approach or One Major Fee Cap/3 in 1
(new practice)

(i . Laboratory tests) + (ii. Specialized investigations) +
(iii. X rays) = $180

# data[].attributes.body
Fee cap were introduced in 1984 for Class B2 and C patients

Purpose is to ensure that subsidised patients would not be put to excessive difficulty in meeting the revised hospital charges due to unnecessary tests/investigations

Currently, fee caps are applied on surgical operations, laboratory tests and specialised investigations, X rays,
rehabilitative services and standard medications

# data[].attributes.body
Patient information

Description of service rendered

Amount of the service

Total payable amount by 3rd party (if any)

Total payable amount by patient

# data[].attributes.body
It is defined as the generation of an invoice for the purpose of payment collection from a customer

# data[].attributes.body
Billing

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Charging for early discharge and late discharge 

# data[].attributes.subject
Charging for early discharge and late discharge 

# data[].attributes.body
To illustrate:

Before 1pm, no charge is imposed.
After 1pm, a quarter day ward charge is imposed.
After 6pm, a full day ward charge is imposed.
A penalty may discourage discharge, patient
rather discharge prior to 6pm since they had paid
the penalty.
Furthermore, a prorated ward charge does not
attract Medisave withdrawal.

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- Ward charges typically relates to the
accommodation, nursing, linen and meals

- Daily Treatment fee relates to services rendered by the consultants or medical officers during ward rounds

- Ideally, this charge is imposed during a nightly batch job after midnight census is completed

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Regardless of the mechanism, there is a need for
charging system to execute the following effect:

- Discount Service codes , a service code that trigger a discount effect on the entire bill

- Surcharge Service codes , a service code that trigger a surcharge effect on the entire bill

- Conditional codes , a code that imposes a surcharge on certain services only . This code may be entered in the form a service code, payer code or a specially designated code.

# data[].attributes.body
1. Item based package

A package defined by a list of items and quantity .
(Similar to Macdonald set meal) or A&E charges in hospital

2. Dollar based package

A package defined by a price tag to treat a specific medical condition . It is usually further defined by list of exclusion. (Similar to a buffet

# data[].attributes.body
Charge entry is a service that has been
performed and is pending data entry.
Order entry is a service that has not been
performed but “ordered”.
Closure of bill refers to instruction issued to the billing system to stop accepting service entries / charge code entries for an account.
A service entered after a bill has been closed is
termed a late charge.
Late Charge: For hospital billing, the bill has to be opened or cancelled if it has already been closed or billed, before any late charge can be entered. Debit or credit note are not raised to manage late charges with regard to hospital billing. Subvention and CCPS submission of claims will be compromised by the issuance of debit or credit notes.
Exploding/Battery Code: The input of a single code, similar to a macro,
that will automatically expands into multiple services. The primary purpose is to save time and effort in entering multiple keystrokes for
data entry staff. Unlike package, exploding/battery code does
not have discounted price.

# data[].attributes.body
Mark up table is used, in the event the medical item used is new and service code has not been created. Miscellaneous charge code is employed, with price determined by a mark up table.

# data[].attributes.headline
Disadvantages of manual entry of services 

# data[].attributes.subject
Disadvantages of manual entry of services 

# data[].attributes.body
Human dependent and prone to error, subject to availability of staff to perform the work as opposed to automated entry by system

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1. Quantity cannot be zero
2. Services must be performed within Length of
Stay.
3. Zero priced items are allowed
4. In the event, service codes are not available.
Miscellaneous codes may be used.

# data[].attributes.body
Batch processing has these benefits:

- 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.

- It allows effective use of manpower, key entries only once

# data[].attributes.body
- Two modes of service codes input:

1. Direct entry of services into billing system by
billing staff (use of charge forms).
You usually use a batch interface to collect transactions
over a period of time and then process all of the
transactions at once

2. Batch or Online interface of services from
ancillary medical system to billing system.
(entry of service items by the various service
stations)
For an online interface system, transactions are processed as and when they are entered

# data[].attributes.headline
Centralized Revenue Management Approach vs Decentralized Revenue Management Approach

# data[].attributes.subject
Centralized Revenue Management Approach vs Decentralized Revenue Management Approach

# data[].attributes.body
- A charge form is a document used by nurses to record the services rendered for a patient.
- Data entry of services will then be performed by billing staff reading from the charge form.
- Services entered into the bill must be reconciled with the charge form
- Charges reviewed regularly to ensure that prices and services are updated.

# data[].attributes.body
Charging (Charge Capture Process)

# data[].attributes.headline
Purpose of Discharge Summary and Interim Bill

# data[].attributes.subject
Purpose of Discharge Summary and Interim Bill

# data[].attributes.body
Discharge Summary
Upon discharge, the summary provides
details of the patient medical condition.
It is given to patient in the event that the
Employer or Insurer needs the medical
information for processing of medical bills

Interim Bill

An interim bill is given for the following
reason:

- To collect any cash outstanding before
patient leaves the hospital

- To ensure patient is aware of his medical
bill upon discharge as a final copy will not
be presented immediately due to CCPS
processing.

# data[].attributes.body
Patients with “F” credit ratings must be submitted to finance for bad debt provision. The bad debt amount must be communicated to the Finance Dept.

Techniques for collection in the ward

- Placing documents in the ward

# data[].attributes.headline
Ward Centric vs Patient Centric Collection

# data[].attributes.subject
Ward Centric vs Patient Centric Collection

# data[].attributes.body
Ward Centric: PSA or ward clerks are tasked with
monitoring the debt of patients.

Patient Centric: 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.

# data[].attributes.body
MCPS is a secure web based medical benefits and  claims processing/ proration system that helps  Singapore Civil Service to centrally manage and  process employee healthcare benefits.

The system, which is integrated with healthcare  providers, insurance companies and various  government agencies, has significantly streamlined  medical claims processes, ultimately enabling public  service employees to enjoy medical benefits at clinics  and hospitals.

# data[].attributes.body
1. Patient details:
- Patient unique identification number
- Name
- Date of birth
- Address

2. Other necessary information:
- Contact number
- 3rd party payers
- Next Of Kin (NOK) information
- Allergy information
- Referral source

# data[].attributes.body
Documentation & Inflight Management

# data[].attributes.body
-Inpatient ward charges,
-Approved day surgeries

Outpatient charges
-Chronic diseases treatment
-Cancer treatment
-Renal dialysis
-Health screening and selected vaccinations
-Community hospital and hospice

# data[].attributes.body
Charges covered by Medisave
Inpatient ward charges ($450 per hospitalisation day)
Approved day surgeries (up to $300 for each day surgery episode)
For surgery (Claims from $250 to $7550 based on the TOSP)

Outpatient charges:
Chronic diseases treatment (20 chronic diseases under CDMP) - similar to CHAS CDMP scheme
*15% co-payment
Cancer treatment
Renal dialysis - $450 per month per patient
Health screenings (mammograms and screening for new born)
Selected vaccinations such as Pneumococcal vaccine for children, Hepatitis B vaccine, HPV vaccines for females (9 to 26 years)
Medisave Maternity Package (for pregnant women) - claim up to $3000 for Natural Delivery and $4850 for Caesarean Delivery.
$300 per year patient per scans needed to diagnose or treat your medical scans (for CT or MI scans ONLY)
For Old Age: $200 per year per patient under Flexi Medisave (aged 60 years and above)

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-A portion of your CPF savings account to pay personal or immediate family medical bills
-Medisave can be used for spouse, parents and children medical bill
-Medisave to pay insurance premiums for many shield and integrated shield plans
- Medisave withdrawal limit has been increased to $500 per year

# data[].attributes.body
-Providing public hospitals subvention funds
-Block funding for patients using subsidized services (Class B2 and C)

-To cover resources such as manpower and consumable supplies

# data[].attributes.body
Lump sum subvention
-Operating funds given to healthcare institution based on budgetary forecast

Piece rate subvention
-Funds awarded based on total number of patients days and volume of outpatient.
-Funding based in usage

Casemix subvention
-Funds based on DRG
-Depends on complexity of treatment

Global budget subvention
-Funds based on lum sump, piece rate and casemix funding principles

# data[].attributes.body
The Community Health Assist Scheme (CHAS) is a scheme by the Ministry of Health (MOH) that enables Singapore citizens from lower- to middle-income households to receive subsidies for medical and dental care at participating General Practitioner (GP) and dental clinics near their homes.

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P01-P12

# data[].attributes.body
- Consent Form
-Payslip/Bank statement
-Means- Test declaration form
-Cinsent to release Medisave/ Medishield Information
-Acknowledgement that FC is performed by  patient signing
-Blll
-Medisave authorization form

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-Individual means testing

o   Inpatient admission

For employed: average monthly income for past 12 months
For self-employed:  monthly income within last two years

For unemployed or no income, received full subsidy (65% Class B 80% Class C)

BUT property with an annual value more than $11,000 they are given subsidies of 50% and 65% respectively for B2 and C wards.

-Household means testing

o   Inpatient downgrading

o   SOC enhanced subsidy

o   ILTC subsidy
o   Medifund application

o   Community health assist scheme (CHAS) applications
- Gross income (no deduction of CPF) of person needing care all spouse and immediate family members.

- Annual value of place residence for household with no income

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Upgrading

o   Will switch the remaining charges to A class

Downgrading

o   Must do a means test (household meanest). To check every family household income

o   Normally only need to give personal income (mean test) to go in but if want to downgrade, household mean test is required.

Downgrading/Upgrading

o    Subject to availability. If no slots, remain put.

·        Follow up at specialist outpatient clinic after discharge

o   Class A/B1 charge at private rate

o   Class B2/C charge at subsidized rate

o   Patient classified under industrial accident charge at private rate (injure during worktime by law company needs to pay)

o   All other citizenship will be charge at private rate

Social over-stayer

o   NOT applicable for Class A1

o   Overstay with no medical reason

o   For patients that doctor say can be discharge but want to still stay in the hospital

o   Charge different rate

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- Estimate bill size must be communicates
(If there is a wrong communication wrong bill size, hospital can be sued.)

Patient must be informed to enable decision such as
-Choice of class, primary, private, sub

-To proceed or not to proceed with treatment

-Seek alternative options at other institutions

-Standard or nonstandard options

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-It is to perform before pre-admission testing
-Before and after admission
-Emergency
-If medical condition change within 48 hours, in need to do of another financial counselling under the PHMC actSubsequent changes to hospital bills due to length of stay, medication, complications, more treatment or drugs.

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-Mandatory under the Private Hospitals and Medical Clinics regulation to go through financial counselling.

-To help/save patients and families from financial burden.

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Audit and checks for MAF Plus

-Data will be submitted to MOH

-Clinical Audits

-All applications go through CMB

(Pharmacist, doctor, CMB must sign)

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-To cover non standard and non formulary
-·Drugs must be listed under MAF plus form

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Clinical evaluation
Evidence of efficacy
Favorable safety profile
Ethical consideration

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-To help lower income patient on medication (drugs)

-Max subsidy 75%
-Per capita income $1,500 and below

-Drugs must be listed under the MAF form

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Level 1- Public Assistance
-Pre Qualified Cases
-Medical fee exemption card
-IMH
-Public Assistance Card

Level 2-Straight Forward Applications
-When recommended  % based on household income are eligible (same or lower)
Approved by medical social worker

Level 3- Non straight forward application
-When % is greater than eligible % based on Household income
-Approves by medifund committee

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-Singaporean 18 years old and below

-Low income family

-Medifund don’t help middle income but Medifund junior helps

-Medifund Junior is based on the hospital bill is high and household income, status of family

-Medifund amount of assistance: Different principles

-Household income per capita

ONLY C class patient can enjoy 100% Medifund assistance