Best Practice Guidelines: Hospital Patient Administration: Finalise Case

Best Practice Guidelines: Hospital Patient Administration

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13. Finalise Case

Responsible Roles


	Ensure all the transactions have been posted and all corrections have been done. Ensure the pharmacy billing is also on the account. Apply the fix fee calculation if a fixed fee is applicable to the case.
	Check if all clinical information were completed and up to date. All results are filled in the file and on the system.
	Ensure all the transactions are up to date and all communication with the medical aid are completed. Check all the codes are correct on the case. Sent the claim to the medical aid. Finalize the case. Email the final account to the private patients.

Purpose of Finalise Case

To ensure all billing and corrections were done on the case. Check the account and audit the account to ensure all are correct and up to date. To ensure the account are ready for submission to the medical aids. Apply the fix fee calculation on the case if a fixed fee are applicable.

Critical Steps of Finalise Case

A Case will be finalized when the file is 100% correct and can be handled off and the claim has been sent to the medical aid. When a Case must be finalized can also be decided on the hospital's processes.

The status of the Case assists in more effectiveness in the hospital's administration and assists in keeping the age of the outstanding amounts low.

All patient billing needs to be audited for accuracy:

Ensure that the following has been billed:

Ward fees
Theatre Fees: Correct minutes, time and theatre used
Equipment: Equipment used per case and indicated on the charge sheet. Certain procedures will always have equipment usage.
Gasses
Stock: Theatre, Ward, Recovery. Best practice will be that the theatre staff sign the charge sheet as proof that all stock used was correctly charted.
Fixed Fees

Ensure that the following items have been updated:

Deposit/Co-payment received from the patient at admission
Any discount that was arranged with the patient prior to admission

Print the detailed account and put on patient file.

Admin Audit

This auditing is focused on:

All demographic information of the patient and the Main member is correct
Next of kin information are completed.
All documents necessary is in the file
Copy of the ID of the Main member and Patient, Medical Aid card, and Auth documentation is in the file
Validation of the patient demographic details are correct and was checked against the medical aids
The file is closed before a private patient leaves the hospital
A private patient has paid outstanding amounts before leaving the hospital
Admittance and Discharge date and time is correct

Nursing and Clinical Audit

This auditing is focused on:

All clinical info is in the file and in the electronic file
The patient is discharged from the system and a signed copy of the discharged form from the Treating provider.
Ensure that all items used on the patient is on the charge sheet and was billed on the patient file
Check if the patient did receive his TTO medication
Bed movement is correct

Bill auditing

In a hospital normally also the nursing staff/theatre sister/scrub sister who assisted with the procedure have to bill the necessary items:

Ensuring that all stock used is indicated on the charged sheets and captured on the patient account.
Ensuring that all Equipment used are indicated on the charged sheets and captured on the patient account.
Ensure all the Accommodation was billed and the days calculated is correct
Ensure that all procedures were billed
All consultations were billed
Billing and stock control must prioritize any private patient file after a procedure is performed.

Code auditing

In a hospital, the nursing staff/theatre sister/scrub sister who assisted with the procedure will work on the system, the code auditing includes but not set:

Does the CPT Codes correspond with the actual procedure that has been performed
Where there any co-morbidities?
Where there any additional procedures that were performed at the same theatre session? Are these codes correctly?
ICD10 Codes, are the ICD10 according to the discharge ICD10 ( Diagnose of the patient )

Financial checks

The account was sent through EDI to the medical aid
Response from medical aid was received
All agreements were met.
Any discount must be authorized by the Hospital Manager.
Discount can only be granted if the patient settles the account on discharge.
The approved Discount journal must be processed on the discharge of the patient

Print statement and check

Print the final account, do the last check for accuracy.
Place the final account on the patient file.
Email the final account to the patient.

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