New billing system at HSA

A new billing system soon to come into effect at the Health Services Authority is expected to net an extra $1.3 million in annual revenue, but hospital administrators say the price of most procedures will not be going up.

On 1 October, the authority will be introducing a new charge master – effectively a list of procedures and their prices – that administrators say will bring the authority into line with global industry best practices and accepted international billing standards.

Under the system that has been in place, the HSA was often left to foot the bill when procedures or services provided by the authority could not be reconciled with the more limited list of procedures and prices that was in place.

The new system will add over 4,000 new procedure codes. While only 1,500 will initially be in use at the HSA, acting CEO Lizzette Yearwood noted the expanded list gives the authority scope to expand services in the future.

‘It is important to note that the current fees for most commonly used healthcare services such as room and board, supplies, medications and ancillary services such as lab, radiology and physiotherapy will remain unchanged with the implementation of the charge master,’ Ms Yearwood said.

She said patients will benefit from quicker settlements and less insurance claim denials under the new system.

The new procedures that are being added will reflect ‘reasonable and customary’ charges laid down by the Health Insurance Commission.

The new charge master comes after the Government approved a 10 per cent, across-the-board fee increase for all HSA services in March. Despite healthcare costs skyrocketing by between eight and 12 per cent annually, it was the first time prices had gone up at the hospital and in clinics since 2002.

Ms Yearwood emphasised that items that were subject to the 10 per cent fee increase in March will not be increased when the new charge master come in on 1 October.

‘This improvement in our pricing structure is one of the many efforts being made to improve our billing process,’ Ms Yearwood noted. ‘The move will more accurately reflect the cost of providing the service.’

The new charge master is one of a suite of reforms introduced in the past year designed to shore up the authority’s financial footing.

After requiring a government bailout of $14.2 million for losses accumulated during the 2006/07 financial year, the authority has been able to cut its annual operating loss to $9.8 million in the 2007/08 financial year and this year expects to slash the figure to $6.4 million.

In January, the HSA decided to turn over late unpaid hospital accounts to a private debt collection agency in an effort to boost its bottom line. Unaudited HSA accounts showed patients owed the hospital over $15 million at the time, $10 million of which was six months or more overdue.

It was followed in March by both the 10 per cent, across-the-board fee increase for all procedures and services and a new pre-registration pilot programme whereby patients are called ahead of appointments to be sure they know how much their procedure is going to cost, how much is covered by insurance and when the bill must be paid by.

In July, the authority launched a charity fund that will help buy much needed but expensive medical equipment and facilities. Already, the fund’s private sector organisers have received a $12 million wish list from the authority.

Ms Yearwood said she is optimistic the authority will be able to continue to reduce its financial reliance on government.

‘We believe we will continue to see a decrease in the need for government subsidy, however at this point in time we are unable to operate without government financial assistance,’ she said.

‘We have to strike a balance between providing top quality care and being as cost effective as possible and we are striving to be fiscally responsible all the time.’

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