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1. MOH requires all healthcare institutions (HCI) to counsel patients on the financial impact of their medical treatment prior to or upon admission. (under the Public Hospitals  & Medical Clinics (PHMC) Regulations)

2. During counselling, patients are provided with information on the estimated total bill for patient's hospitalisation, comparative information on the average bill size per day at the various public and private hospitals, as well as information on Medisave and Medishield, including financial assistance scheme such as Medifund.

-patients have a good idea what bill size should look like and be provided details of itemised charges for medical condition they are admitted  for.
This is to enable patients to make the following decision:
1. choice of class, primarily private or subsidised
2. proceed or not to proceed with treatment
3. seek alternative options at other institutions
4. standard or non-standard options

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Helps healthcare institutions because if the HCI can identify patients who have difficulty paying for the treatment and take appropriate action to help them.

This reduces the possibility of bad debts from occurring & reduce amount of debts owed by patients.

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Before Financial counsellors begin the FC, there are a few things to take note:
Conduct the FC in a location that will protect the privacy of the patient
-This is to ensure that patient's confidential information is not leaked or overheard by someone else

Verify and confirm the patient's identity
-This is to ensure that the FC is conducting to the correct patient.

Verify the identity of the person the information will be shared to
-This is to ensure confidentiality of the information shared. It is also to confirm that the NOK/3rd party is allowed to decide on behalf of patient

Allow patient to choose the ward
-Patients/NOK to be introduced to different class of wards and their charges
-A chart showing the maximum subsidy for B2 and C Class prices are shown to the patient
-Patients are informed that subsidies may vaires due to Means Testing
-Allow time for patient/NOK to decide. Do not rush them.

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Financial Counselling Rules and Regulations 

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Financial Counselling Rules and Regulations 

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During financial counselling, the patient may request to be upgraded or downgraded.
Upgrading
Should patient request for upgrading to a higher ward class, all charges(except patient daily standard ward fee) incurred at the lower ward class up till the upgrading will be recomputed and charged at the higher class rate.
Downgrading
Patients can be downgraded from private to subsidised ward class if they pass the downgrading procedure (means testing using Household Monthly Income per capita)
Downgrading/Upgrading is subject to availability of beds and takes effect when the patient physically occupies the lower/higher class bed.

Class A/B1 will be charged at private rate
Class B2/C will be charged at subsidised rate (Only for Singaporeans and PRs)

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The financial counsellor will get patient's consent to obtain patient's information before conducting means test. The system is checked to see if there is a recent valid means test conducted. Each means test is valid for 1 year.

Individual means testing-inpatient admission

Household Means testing (PCHI)-Inpatient downgrading, ILTC subsidy, Community Health Assist Scheme (CHAS) application, Medifund application

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Service quality during financial counselling 

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Service quality during financial counselling 

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1. Open-ended questioning
This would allow patients the opportunity to speak and voice out their concerns. It will give financial counsellors the opportunity to get more information from the patient who may be too embarrassed to say, eg. not enough money to pay for treatment
2. Empathetic and active listening
This is a listening and questioning technique which allows the listener to develop and improve relationship with the speaker. It will enable the listener to develop a stronger intellectual and emotional understanding of what is being communicated by the speaker. The listener also repeats what he/she thinks the speaker has said to make certain the understanding is correct. It also involves reading body language of the speaker to understand the emotions.

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charging and coding (falls under middle part of the Patient Revenue Cycle)

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charging and coding (falls under middle part of the Patient Revenue Cycle)

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Pricing-is the activity of establishing a price for your patients. There are different prices for the same services because of different patient class, subsidies, surcharges, discounts, packages, and place where the services are provided
Coding is the activity of setting a "Code" for services rendered. Some codes may be specific while others are general or miscellaneous codes.
Coding can also refer to assigning the correct ICD code for services. This is for Subvention and Casemic claims.
Charge Capture & Service Entry is the activity of capturing services rendered to patients. It can be performed manually or electronically.

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The prices and services codes need to be confirmed before staff can use them for billing.
All service codes are compiled together into what is known as a Charge Description Master.
The Charge Description Master (CDM) is a database of all the billable services, consumables and medication of the hospital. It contains the Service Codes, Desciption, Prices of the billable items. Items in CDM should be similar to that in the billing system.

-This is printed out or placed in the counters or consultation rooms. Staff can refer to it if they are unsure of what service code to key in the billing system or the correct price to charge.

However, it has to be reviewed and updated regularly. This is done by the Finance Department.

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-needs to be reviewed regularly by the Charge Description Analyst to ensure that:
-the prices reflected are updated
-new items are updated
-obsolute items are removed

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-if not reviewed regularly, there will be outdated service/product prices, obsolute or duplicate service/ product codes.
-negative impact to the hospital's revenue, i.e. results in revenue leakages, disputes with patients, complaints from patients, confusion among staff about prices, products or services, billing inconsistencies, frequent re-submission of claims (eg. Civil Service Claims, Medishield Life and ISP claims and Medisave Claims)

-increased usage of Miscellaneous Codes (Generic Codes) resulting in loss of data on services and products offered to patients.

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Periodic review of a hospital's CDM can often review breakdowns.
-Inaccurate charge descriptions for services or supplies in CDM.
-Inconsistent pricing across departments for similar services
-Obsolute charges are in the CDM
-Miscellaneous charge codes

Administration of the charge capture process
-clinical staff is not capturing all appropriate charges
-system limitations
-Inadequate monitoring of daily department revenues
-Ineffective and insufficient charge capture tools