Not true that e-filing medical claims raises costs

Not true that e-filing medical claims raises costs

MOH's Reply

The Straits Times, 5 April 2018

Not true that e-filing medical claims raises costs

We thank Dr Thomas Lee Hock Seng for his letters (More flexibility needed over electronic filing of medical claims, March 22; and Higher healthcare costs: Consider less obvious factors too, April 1).

Last year, about four million healthcare claims were submitted by about 1,800 approved medical institutions on behalf of their patients.

The Ministry of Health (MOH) requires Medisave and MediShield Life claims to be e-filed as it is more cost-and resource-effective compared with processing the high volume of claims manually.

Dr Lee suggests that one of the factors contributing to higher costs in private hospitals is the requirement for e-filing.

This observation is however not backed by evidence in practice.

MOH's e-filing system can be integrated with the provider's clinic management system.

In these cases, there is no additional cost involved for the clinic or hospital to submit claims for their patients.

Where clinics do not have such a system, e-filing can still be completed through an Internet Web portal.

It is difficult to understand why the clinic would incur higher costs when they submit claims through the Web portal compared with the alternative of submitting claims manually via hard-copy forms.

The latter arrangement is likely to be costlier and more time-consuming for both the clinic and its patients.

E-filing minimises errors, and enables the high volume of claims to be processed accurately and quickly for the benefit of doctors and patients.

Lim Siok Peng (Ms)
Director, Corporate Communications
Ministry of Health

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Forum Letter

The Straits Times, 22 March 2018

More flexibility needed over electronic filing of medical claims

In senior health correspondent Salma Khalik's report, the Singapore Medical Council "acknowledged that there is no prohibition against hospitalising a patient for what is normally a day surgery", even as it warned doctors not to do so if it was unnecessary (Doctors warned against overcharging, overtreating <http://www.straitstimes.com/singapore/doctors-warned-against-overcharging-overtreating> ; March 20).

I believe there are occasions when patients are hospitalised for day surgery because that is the only way the doctor can submit an insurance claim on behalf of the patient, due to the Ministry of Health's (MOH) mandate for electronic filing of claims.

MOH imposed electronic filing to facilitate efficiency in processing paper work, including for Medisave reimbursements, and insurance claims.

Most specialist clinics run a tight ship to keep costs manageable. But, the digital push to boost efficiency has added to their cost as they need to hire additional staff to do electronic filing.

Patients who opt for day surgery are unable to claim their insurance cover if a specialist clinic does not have staff to do electronic filing.

The only option is to be hospitalised since all hospitals, public and private, are set up to comply with the MOH mandate of electronic filing.

I have personally had my claim turned down by my insurer because I opted for a day surgery procedure in a specialist clinic without electronic filing.

In my attempt to save the insurer from paying a higher claim, I ended up being denied my claim by the insurer.

Our bureaucrats must pay attention to details when implementing government policies.

The insurers must realise that refusing to accept non-electronic filing is not saving them from bigger claims. But, again, what can they do if MOH says all claims must be electronically filed?

Let me give you a frightening scenario.

Suppose I have to seek medical help overseas while travelling, and the hospital or clinic in that country has no facility to file my claim electronically to my insurer.

Would my insurer deny me my claim in this situation?

Would Medisave refuse to reimburse my insurer because my claim did not comply with MOH's mandatory electronic-filing protocol?

Thomas Lee Hock Seng (Dr)

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Forum Letter

The Straits Times, 1 April 2018

Higher healthcare costs: Consider less obvious factors too

The ongoing debate on containing the spiralling cost of healthcare seems to have reached a conclusion - minimising consumption of medical services will produce fewer insurance claims and, hence, premiums will not rise so much that consumers end up bearing the brunt.

In other words, underwriters have to ensure that providing insurance cover must remain profitable and consumers must reduce their consumption to keep claims within profitable limits for insurers.

One of the factors contributing to higher costs in private hospitals is the Ministry of Health's (MOH) mandatory requirement for electronic filing of claims by specialist clinics that rely on the hospitals to facilitate this process, adding to the cost as they need to hire additional staff to do electronic filing.

If MOH wants to dig into the real drivers of the spiralling costs of healthcare insurance, it needs to be open to the possibility that other factors apart from the obvious ones may be responsible. It behoves the health authorities to seriously examine their assumptions and current processes.

Thomas Lee Hock Seng (Dr)