Best Practice Guidelines: Healthcare Practice Management & POPIA Compliance Framework

Best Practice Guidelines: Healthcare Practice Management

POPIA Compliance Framework

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13. Receipting: Roles & Purpose

13.1. Receipting Business Processes

Preliminary remarks

Cashflow = Receipts - Receipts written back - Refunds.

Receipting will increase the cash flow figures on the debtor transaction drill-down report (daybook report) and will increase the amounts in the relevant cash books (eg EFT cash book, card transaction cash book and cash book). These cash books should be reconciled daily with the cash register/tin, the card summary slip and the bank statements to make sure all money has been received in the bank account.

Receipting will also decrease the patient's outstanding account, leaving only the balance, if any, to be collected via the age analysis or other debt collection process.

After a patient’s invoice has been sent to the Medical Aid, the Medical Aid will respond with an indication of whether the full claim amount is accepted or rejected or whether only specific codes are accepted or rejected.

If a whole claim or some specific code(s) of a claim were rejected by the Medical Aid, the patient will be liable for the outstanding amount. The Cashier will collect payment as soon as possible from the patient and allocate it correctly to the patient’s account. Due to the real-time switching capability to most Medical Aids, the Cashier is able to see what the patient should pay before he or she leaves the practice to fully settle the outstanding account.

Item Level and Invoice Level Allocations

Receipts can be posted on an Invoice Level or Item Level, depending on the practice’s needs.

Invoice Level allocation will allocate the total receipt amount on the invoice as a total. This function allocates the amount to the entire outstanding invoice. This is only advisable if it is a cash practice and the patient always pays before leaving.

Item Level allocation will allocate the items on the receipt to each invoice item/invoice line by matching the procedure and stock codes. This function thus allows the practice to allocate each amount to the specific outstanding items so that rejected items/codes can be communicated to patients for collection. If patients want to follow up rejections with their Medical Aids, they have the necessary information available.

Cash Books

Receipts allocate payments to cash books. Cash books can be configured to indicate the methods by which patients and Medical Aids have paid and allow the practice to reconcile the different types of payment methods to the card machine, cash or bank statements. 

All patient receipts will be allocated to one of the cash books depending on the method the patient used to pay their account, eg cash, EFT or by card payment.

For more information on the cash books and reconciliation of the cash books, please refer to the Healthcare Management Internal Controls book and Accounting course in GoodX.

Patient Receipt

A Patient Receipt will allocate the amount to the Private Outstanding side of the account. This will confirm that the payment was made by the patient. The cash book will indicate the payment method and the receipt can be done on Item Level or Invoice Level. This will be for any deposits or co-payments as well that the patients pay. The amounts will be allocated to the Invoice for the service rendered and be deducted from the amount owing.

Medical Aid Receipt (Desktop App) and Remittance Advice (RA) (Web App)

A Medical Aid Receipt will allocate the amount to the Medical Aid Outstanding side of the account for invoices that were submitted to the Medical Aid. This will confirm that the payment was made by the Medical Aid. A Medical Aid Receipt will be used for Medical Aids that don’t have the ERA functionality and practices that are not using the ERA function. The cash book will indicate the payment method and the receipt can be done on Item Level or Invoice Level.

The Remittance Advice (RA) function in the Web App will be used to build remittance advice in the software that will reflect the hard copy that was received from the medical aid.

Cash Register

Patient Receipts can also be done from the Cash Register module, which allows the practice to have more control over cash in the practice. The Cash Register module works with sessions and after each session, a cash-up must be done and the Practice Manager should do a reconciliation of the money before it is sent to the bank or moved to the petty cash. The Cash Register is a function that can be used to control cash and card payments.

Electronic Remittance Advice (ERAs)

ERAs save a lot of time and leave less room for human error in the capturing and allocation of payments received from medical aids. Manual interventions are few and the time saved with the ERAs can be better used to do debt management or other necessary tasks.

ERAs are electronic documents that are received from Medical Aids and imported into the system to indicate which accounts and line items were paid and which accounts and line items were rejected. ERAs are used to allocate payments from Medical Aids to patient accounts per line items.

Take note: ERAs must only be imported and posted when the payments have been confirmed by checking the practice’s bank account and not upon receipt of the ERAs.

Refunds (Desktop App)

Refunds are done when a patient has overpaid their account, or if both the patient and Medical Aid has paid for the same invoice.

Take note: Before making refunds to Medical Aids, check first whether the Medical Aid will deduct the overpayment from the next remittance payment that the practice will receive. 

Refunds will create a positive amount in the patient’s account. Make sure that the bank details are correct before effecting the refund. When a refund must be done, the payment must be marked as a cash payment or an electronic payment, depending on the method used. Remember to use the Payment to Patient function in GoodX to indicate that there was a refund if the Practice is refunding the Patient. If it is a refund to the Medical Aid, the Medical Aid will deduct the money from the next payment run from the debtors account on the system.

Link Unlinked Receipts / Amend Linking

The Unlinked Receipt line/column in the receipt screen was designed for patients who pay for services and stock in advance. Eg practices that take deposits before private patients visit the Practitioner, will post receipts without the ability to link them to the invoices that will only be created after the consultations.

If a receipt is not linked to its corresponding invoice, the account will show both a debit and a credit after billing and receipting was done and reports will show the invoice as outstanding.

The age analysis will also then show the debit and credit and if the practice does not draw the age analysis for both debits and credits, a wrong debt collection message could be sent to the debtor, resulting in embarrassment to the practice.

To correct this situation, all unlinked receipts must regularly be linked to their corresponding invoices. The invoices will then be marked as paid.

If a receipt was linked to the wrong invoice, the linking must be corrected.

Desktop App - A Zero Receipt OR the Autolink button will be used to link the unlinked receipt. This will ensure that the cash flow does not increase when the receipt is linked to the correct invoice.

Web App - Will auto-link the invoice to the unlinked receipt if the amounts are the same as on the receipt and the invoice.