Dr.
Ngun Kok Wah.
Consultant
Anaesthetist,
Subang
Jaya Medical Centre.
13
April 2000.
Ms.
Elaine Cheong,
Financial
Controller,
Subang
Jaya Medical Centre.
Dear
Ms. Cheong,
Re: 1 Late
Activity Charges Due to Late Submission by Surgeons
2 Anaesthetic
Charges When Surgeon Elects to Reduce or Forgo His Charges
The
anaesthetists had on a meeting on 4 April 2000 and among the issues discussed
were the two items listed above. Below are our opinions and decisions.
Late Activity
Charges
Due to Late Submission by Surgeons
It
was noted that for the anaesthetists, the bad debts written off in the recent
exercise were almost all classified as late
activity charges. This was in spite of the fact that the anaesthetists had
almost always submitted their vouchers on time, at the end of the operation.
This indicated that, the charges had been classified as late because the
surgeon had submitted their vouchers late.
There
have even been instances whereby the operator may have completely forgotten to
submit his vouchers, the staff has lost the anaesthetists' vouchers or the IT
staff have forgotten to enter the anaesthetists' charges after receiving the
surgeons' charges. There is, therefore, a need to improve the current system.
It
was agreed that there were 2 issues here.
1.
Based
on legal advise, it is our opinion that once the anaesthetist has submitted
his voucher, the onus was on the hospital to ensure that the patient was duly
billed and that the charges would not be considered late activity charges as long as the anaesthetist had submitted his
vouchers before the patient was discharged, even if the surgeon subsequently
submitted his voucher late.
2.
We
had to develop a system to prove to the hospital that we had indeed submitted
our vouchers on time, i.e. before the patient was discharged.
Proposals
1.
We
feel it is incumbent upon the hospital to contact the surgeon immediately
when, on discharge, the surgeon has not submitted his voucher yet. If the
surgeon is uncontactable or elects not to charge the patient, the anaesthetist
must be informed immediately so that he may either try to contact the surgeon
himself or to enter his own codes if necessary. In this regard, the hospital
must use all means to contact the doctors involved to avoid any problems
later. It is not acceptable to have just paged once for the doctors.
2.
We
propose that special voucher books be printed for the anaesthetists, as we are
the only specialty affected in this fashion. The special voucher books will
have 2 carbon copies. The original will be the actual invoice. One copy shall
be countersigned by the staff to whom we have submitted the vouchers. This
copy will be immediately returned to us. The second copy will be time stamped
by the IT Department and will be returned to us together with our Daily
Revenue Lists the next working day. In this way, we have proof that we have
submitted our voucher and secondly we will know by the next working day if IT
has not received our voucher.
3.
The
Hospital Information System (HIS) should be reprogrammed so that when the IT
Department receives the anaesthetist's voucher, an entry should be made for
the anaesthetist with a special code. When the surgeon puts in his charges,
this code should be cancelled. On discharge, the HIS should automatically
check for this code which will serve as a flag to indicate that the
anaesthetist has submitted a voucher but that the surgeon has not submitted
his charges. Then the steps mentioned in 1 above must be followed.
Anaesthetic
Charges When Surgeon Elects to Reduce or Forgo His Charges
Occasionally,
the operator may, for various reasons, decide to either reduce his charges or
not to charge the patient for the procedure. In this instance, the
anaesthetist has the option to either follow the surgeon or to charge the
patient as he deems fit. Ideally, the surgeon should indicate the anaesthetic
fee in his voucher. However, if this has not been done, the accounts staff
discharging the patient must contact the anaesthetist to ensure that his
charges are entered if he so desires.
I
hope that the above proposals will receive a favourable reply from you. We are
open to any suggestions, whether they be improvements on our proposals or
completely different proposals. Please feel free to contact me to further
discuss our proposals, as I am sure there are many points you will want to
clarify.
Dr.
Ngun Kok Wah.
Consultant
Anaesthetist,
Subang
Jaya Medical Centre.
cc
Dr.
Jacob Thomas,
Director,
Subang Jaya Medical Centre.