Hospital Services - How To Create and Configure

MediRecords can help medical practices improve efficiency, reduce errors, and enhance patient care.

Here are some of the key features and benefits of MediRecords Inpatient Care.

1. Scheduling:  Appointment scheduling, allowing patients to easily book appointments online and helping staff manage the schedule more efficiently.

2. MediRecords can store patient information and medical records in a centralised database, allowing providers and staff to access patient information quickly and easily.

3. Billing and Claims Processing: MediRecords online ECLIPSE billing process, from generating invoices to processing payments. 

4. Reporting and Analytics: MediRecords can provide reports on patient volume.

Overall, MediRecords can help medical practices improve efficiency, reduce costs, and enhance patient care.

Getting Started

How to configure a provider for Hospital services and ECLIPSE Claiming?

Follow these steps:

1. Select More
2. Select Settings
3. Click Subscriptions Details
4. Select Users
5. Once Users is selected, this will bring you to a list of users in MediRecords. Click the tick box next to the provider you need to configure for ECLIPSE. Click Configure, and this will open the table for the provider.
6. Select ECLIPSE at the bottom left-hand side of the table. Complete all the required fields for ECLIPSE Claim Type, Fund Payee ID, and Max Known Gap for all required health funds.

NOTE: Hospital contacts are Required to provide Hospital services and ECLIPSE billing and must include the hospital's Facility/Hospital ID.

Creating a Hospital contact

Here are the steps to create a hospital contact as a Service Provider:

1. Click More
2. Click Resources 
3. Select Contacts
4. Select Service Providers 
5. Select New
6. Fill in all the details for the Hospital
7. In the Facility/Hospital ID field, enter the hospital's unique ID number, which is required for ECLIPSE billing.
8. Save the contact.

Once you have created the hospital contact as a Service Provider, you can use this contact to bill in-patient services.

Click on the link to know more on How do I Create a New Service Provider Contact?

Adding a Room

Now that the contact has been created, it can be added as a room to bill from your chosen practice. To do so, follow these steps

1. Select More 
2. Select Settings
3. Click Subscription Details
4. Select Practices
5. Tick the box next to the name of the practice you wanted to edit
6. Click Edit Practice

Click on the link to know more on How do I Add a Room to my Practice?

Claim Types

Agreements 

Where an organisation, hospital or a medical group has signed an agreement with a fund. 

Agreements between hospitals or medical groups and private health funds are common in the healthcare industry. These agreements are designed to ensure that patients who are members of the health fund can receive medical treatment from the hospital or medical group at a reduced cost, or with no out-of-pocket expenses.

The Hospital Purchaser Provider Agreement (HPPA) or Provider Agreement (PA) is an agreement between the hospital and the private health fund. This agreement outlines the services that the hospital will provide to the health fund's members, as well as the payment arrangements and other terms and conditions of the agreement.

The Medical Purchaser Provider Agreement (MPPA) is a similar agreement, but it is between the medical provider (such as a diagnostic service provider or hospital) and the private health fund. This agreement sets out the terms under which the provider will offer their services to the health fund's members, including the fees that will be charged and any limitations or exclusions that may apply.

Schemes 

Healthcare providers directly enroll with a private health insurance (PHI) company. Under such programs, there are two types of coverage options: No Gap and Known Gap cover.

No Gap - Patients do not have any out-of-pocket expenses for the healthcare services provided by the enrolled provider. This means that the insurance company will cover the entire cost of the treatment.

Known Gap - This means that patients have an out-of-pocket expense for the healthcare services provided by the enrolled provider. In this case, the provider is required to provide written Informed Financial Consent, which explains the cost of the treatment and any out-of-pocket expenses that the patient will be responsible for. The insurance company will cover a portion of the cost, and the patient will be responsible for paying the remaining amount.

Patient Claim

This is where the patient will pay for the services provider and will claim back from the PHI themselves. 

A full detailed receipt of services and provider numbers are given to the patient to enable them to claim back the funds from the PHI, according to their PHI policy.

AGC

Access Gap Cover (AGC) is a private health insurance option that can help you reduce or eliminate the out-of-pocket expenses, also known as the gap, for medical services you receive in the hospital.

What is a Fund Payee ID?

Private health insurers issue their own unique identification numbers to healthcare providers for streamlining the payment of claims.