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· A. Eligibility and Registration
My clinic is already participating in ‘Medisave for CDMP’ but is not registered for CHAS. How do I register it for CHAS and do I need to re-register for CDMP?
If your clinic is already accredited under the ‘Medisave for CDMP’ framework, then you do not need to re-register for ‘Medisave for CDMP’. Please click here to register for CHAS. The assigned polyclinic administrator will follow-up directly with you to sign the CHAS contract.
My clinic is currently not participating in ‘Medisave for CDMP’ or CHAS. How do I register it for CDMP and CHAS?
You can jointly register your clinic for CDMP and CHAS accreditation. Please click here for joint registration.
As a doctor, do I need to register for CDMP and/or CHAS?
To participate in CDMP, and thus also for CHAS, doctors providing treatment need to be accredited under the Medisave scheme by MOH. Doctors who are already accredited under the Medisave scheme do not need to register separately for CHAS, if their Medisave accreditation is still valid.
Medisave accreditation for doctors is renewed every two years. MOH will send you a reminder letter when your Medisave accreditation is due for renewal.
Doctors who are not yet Medisave accredited or who need to renew their Medisave accreditation, please click here .
Why must the medical clinic be CDMP accredited to provide services under CHAS?
I would like to participate in CHAS but I do not expect to make Medisave claims for my patients. Do I still have to complete all the setup and paperwork for the submission of Medisave claims (Contd)
(Contd) such as applying for GIRO with CPF Board/NCS and purchasing the token card etc.?
Although you may not expect to use Medisave for CHAS patients, your patient may be able to use the Medisave accounts of his immediate family members to help pay for his treatment. To avoid delays in such cases, clinics are encouraged to complete all the setup and paperwork for the submission of Medisave claims to enable you to make Medisave claims for both your CHAS and non-CHAS patients.
How will I know if my application is successful?
When do I attend the clinic training required for CDMP accreditation?
The clinic training requirement for Medisave CDMP accreditation is now conducted through e-learning. Users can complete the accreditation at their own convenience. There will be no more classroom training for Medisave accreditation.
To register for e-learning, please click here.You may also wish to apply for training exemption via this link. The registration will take approximately 2-3 working days to process. Thereafter, you will receive an email notification with e-learning login details. Please note that if your clinic is currently not Medisave-accredited, you will need to first submit an application for accredition before registering for e-learning.
Who will sign the CHAS contract with me? When will this happen?
Can I choose which polyclinic administrator I would like to sign the CHAS contract with?
· B. Services Provided
Who qualifies for treatment as a patient under CHAS?
Patients who hold a valid CHAS, Pioneer Generation (PG) or Public Assistance (PA) card are eligible to receive subsidies for treatment of conditions covered under CHAS. For patients with the Public Assistance (PA) card, there will not be any patient payable amount, and the cost of the bill will be reimbursed in full to the clinic.
Merdeka Generation seniors will receive special CHAS subsidies at CHAS clinics from 1 November 2019.
How can I help my needy patients to apply for the CHAS card?
What types of medical treatment can be claimed under CHAS?
What do CHAS subsidies cover?
Where do I send a CHAS patient to if he needs a laboratory test or X-ray as part of his treatment? Does CHAS subsidy cover the cost of such investigations?
· C. Patient Visit
Are both the patient and I still required to sign the CHAS Patient Consent Form (PCF)?
For visits on/after 1 January 2017, you and your patient no longer need to sign the PCF. This is because your patient will be deemed to have given their consent for your clinic to disclose their information with the Ministry of Health and its authorised agents, when they use the Health Assist or Pioneer Generation card at your clinic.
For your existing signed PCFs, please retain them for at least 6 years from the time they were signed, as per the 2015 National Guidelines for Retention Periods of Medical Records. Original paper records may be destroyed upon digitisation of medical records, as long as the copies are accurate and satisfy the legal requirements for admission as seconday evidence in court.
How do I categorise CHAS patients into Simple chronic vs. Complex chronic? (Contd)
(Contd) Can a patient be re-categorised from simple chronic to complex chronic and vice versa? How should this be reflected?
Please refer to the table below for the clinical definitions of how to classify patients into the correct tier.
Table: Patient Classification According to Disease Severity
Complex chronic
This assessment should be done during each patient visit. The claim made for the visit should reflect the tier assigned, based on the GP’s assessment of the patient’s condition for that visit. If during the course of managing the patient’s chronic condition(s), the patient develops complications or his/her condition improves, the patient should be re-classified to complex chronic or simple chronic accordingly. Clinical data submitted for the patient should match the tier assigned. For example, if the patient is diagnosed as having diabetes and hypertension, clinical data should be submitted for both conditions as per CDMP requirements.
Can a CHAS patient see me for both acute and chronic conditions in the same visit?
Conditions covered under CHAS Acute can be claimed as part of a CHAS Chronic claim only when the patient consults the doctor on both CHAS Acute and CHAS Chronic conditions during the same visit. For such CHAS Chronic claims, the CHAS Acute claim cannot exceed the maximum CHAS Acute subsidy (i.e. $18.50 for CHAS Blue and $28.50 for PG) that the patient would have been eligible for if a separate visit/claim had been made for the CHAS Acute condition(s).
Is there a limit on the number of visits a CHAS patient can make?
It is generally not expected that a patient would need to make more than 1 visit a day or more than 4 visits per month to the clinic. Clinics are also not allowed to make more than one acute or one chronic claim on the same day for the same patient.
From 2020, MOH will be instituting a limit on the number of visits for common illnesses allowed under CHAS to be 24 per year per patient, across all CHAS clinics. We have assessed that it is not expected that more than 24 visits per year would be required for common illnesses. This guideline has been put in place to limit potential abuse of subsidies and to ensure that patients with multiple, frequent visits and might potentially require specialist or hospital care are reviewed in the appropriate setting in a timely manner.
If I have a patient who is currently being seen at the polyclinic for his chronic conditions but wishes to seek treatment with my GP clinic under CHAS, how can I access his previous medical (Contd)
(Contd) records to continue their care?
Patients will need to obtain a memo from their previous polyclinic doctor so that you may provide the continuity of care. Alternatively, medical history will have to be obtained from the patients.
· D. Clinical Data Submission
Why must I submit clinical data for the patient’s chronic condition(s)? How and when do I submit this data?
Clinical data submission is a key component of the CDMP framework, which is important to MOH as it allows for the evaluation of clinical outcomes with the goal of improving overall health of the population. For individual GPs, clinical data submission is equally important as a clinical quality improvement tool for self-evaluation. For a more detailed discussion of clinical data submission requirements and benefits, please refer to the latest Handbook for Healthcare Professionals 2018.
For those clinics using the CMS platform, submission of clinical data for your CHAS patients can be done directly within CMS itself using the same method as for CDMP submissions. For clinics doing web-based submission of claims, the submission of clinical data should be done via the MOH Healthcare Claims Portal(MHCP).
If I have a CHAS patient who is using Medisave to pay for his bills in addition to the CHAS subsidy, (cont'd)
(cont'd) must I submit two sets of clinical indicators on MediClaim as well as MHCP?
For such patients you would only need to submit clinical data either via the MOH Healthcare Claims Portal (MHCP) or CMS. The same set of clinical data does not need to be re-entered on MediClaim as it will be integrated backend at the database level.
· E. Financial Matters
How much should I charge the patient?
Can I help a CHAS patient make a Medisave claim for his treatment?
If a patient consults more than one GP for his chronic conditions, would I still be able to draw on the full annual subsidy or is this shared between the GPs?
How do I check my patient’s balance for his annual subsidy for the treatment of chronic condition(s)?
If patients who come to see me for chronic treatment have already made claims up to their annual subsidy cap, can I make an additional claim?
How are patients tier classification – simple chronic or complex chronic registered by the system? (Contd)
(Contd) Is the tier classification for the purposes of determining the annual subsidy cap the same as the classification for each visit?
The assignment of simple chronic or complex chronic classification is done via the CHAS claims process. Each visit claim should include a tier classification for the patient. Based on the history of assigned tiers for past claims, the system will set the annual subsidy cap that will apply for the calendar year accordingly. Regardless of the annual subsidy cap that is in place for the patient, GPs should assign the appropriate tier classification to the patient at each visit based on their diagnosis of the patient’s condition at that point in time, as the clinical data submitted would need to match the tier classification assigned.
Will there be transaction fees deducted for submitting claims and clinical data?
I submitted a CHAS claim but it was rejected. What are the possible reasons for this?
I checked the annual subsidy balance for my patients prior to submitting the claims and there were sufficient balances for the amount being claimed. (Contd)
(Contd) However, I was subsequently informed that the claims were unsuccessful, as the CHAS annual subsidy cap for patients had been exceeded. Why did this happen?
This could happen if there is a lag between the time you checked the balance and when you submitted your claim. In the interim, additional claims could have been made that used up the annual subsidy balance.
For example:
Since the claim for Visit 4 was only submitted on 30 Nov, the balance was used up by the claim submitted for Visit 5 in between the time the balance was checked and when the claim for Visit 4 was submitted.
When will the polyclinic reimburse my claim?
You will be reimbursed within 1 month from the receipt of your claim if there are no queries. If there are queries relating to your claim, payment will be made to you within 7 days after the resolution of all such queries.
Are we required to issue itemised bill to all CHAS patients?
Itemised bills will help your patient better understand the charges for the services and medication received, and know how much CHAS subsidy the clinic is claiming for him/her.
From 1 January 2017, all CHAS clinics are required to issue an itemised bill to all CHAS (including PG and Public Assistance) patients. This includes patients whose charges are covered fully by CHAS subsidies and do not make any out-of-pocket payment. The itemised bill must at least state the following:
Please note that if your clinic already issues bills that are more detailed, you do not need to make any changes to your bill format.
Minimun level of bill itemisation required:
Description
Price (Before Subsidy)
(Example)
Consultation
$20.00
Medication
$15.00
Investigation
$5.00
Others (e.g. procedures)
$0.00
Total Bill Before Subsidy
(including GST, where applicable)
$40.00
- CHAS Subsidy
$18.50
= Amount You Pay
$21.50
You may contact your clinic’s AIC account manager to seek any clarification or help if needed.
· F. Referrals to Specialist Outpatient Clinics (SOCS)
If I refer CHAS patients to a SOC for treatment, will the patients be charged at a subsidised rate?
Can such subsidised referrals be made for conditions not covered by CHAS? Can I refer a CHAS patient directly for specialised tests at the SOC to be charged at subsidised rates?
The referral is not limited to the conditions that are covered by CHAS. For example, you can refer a CHAS patient to the SOC for suspected cancer and this would still be considered a subsidised referral. However, the subsidised referral must be made to the SOC and not directly to the laboratory, to ensure that the test ordered is necessary for the patient’s condition.
Can CHAS Green cardholder qualify for subsidised referrals to SOCs in public hospitals?
· G. Audits
What aspects of compliance could I be audited on?
The polyclinic administrators may conduct operational and clinical audits on your clinic to check for compliance with the CHAS guidelines. The following table summarises the areas of compliance that may be audited:-
• Patient Consent Forms (PCFs) are required to be submitted for audit, for visits before 1 January 2017. For visits on/after 1 January 2017, clinic would no longer need to submit the PCFs for audit.
• Patient's classification into simple chronic or complex chronic was in accordance with his level of disease severity, and for condition(s) with complication(s), that the causal relationship or link between the condition(s) and its complications was documented.
• Clinical data was submitted as required under the CDMP guidelines.
• Financial data was submitted for each visit for which a claim for Subsidy reimbursement under CHAS was made as required in the contract.
• The CHAS Subsidy was used in accordance with specifications in the contract and such guidebook or guidelines that the Administrator or MOH may issue regarding CHAS (Medical), and in particular, that the CHAS (Medical) Subsidy for Chronic Conditions was used for the treatment of Chronic Conditions according to evidence-based treatment programmes and that regard was had to, amongst other things, clinical practice guidelines issued by MOH for chronic disease management.
What types of documents must I keep for audit purposes?
Who will conduct the audit?
When will audits be conducted?
What will happen if discrepancies are found during an audit of my clinic?