A STUDY TO ASSESS THE FUNCTIONING OF BILLING DEPARTMENT IN A TERTIARY CARE HOSPITAL

Transcription

1 A STUDY TO ASSESS THE FUNCTIONING OF BILLING DEPARTMENT IN A TERTIARY CARE HOSPITAL 1 ASHARANI N A., 2 RAMACHANDRA KAMATH U., 3 H N NAGESHA. 1 Post-Graduate Student (MHA), 2 Assistant Hospital Administrator (M.S Ramaiah Hospital), 3 Associate Professor (M.S Ramaiah University of Applied Sciences) M.S. Ramaiah University of Applied Sciences, Bengaluru 1 asharanina@gmail.com Abstract The hospital billing process is mainly to obtain remuneration for the services and materials provided by hospital to patients. On the basis of literature review it was found that there is a gap to study the hospital inpatient billing process in detail as a separate entity and to identify the factors influencing delay in billing process of insurance patients in a tertiary care hospital. The aim of this study was to evaluate the functioning of billing department in a tertiary care hospital as it plays an important role, as liaison office between the management and the patients. Billing process is the final step in hospital, which is directly proportional to patient satisfaction. Billing plays a vital role in the discharge process and billing documents are even legally important. An observational and descriptive study was conducted by using flow chart and root-cause analysis as a statistical tool for analyzing & understanding the billing process in detail and to identify the factors influencing delay in submission of insurance patients bill for my research. The study results that there is a delay in the submission of insurance patients bill and for the same 23% of cases are imposed for deduction. The reasons for delay in submission are as reporting of investigations, files kept in ward without dispatching, incomplete file, absence of process monitoring, lack of training, resubmission of documents or bills, shortage of manpower and so on. Some of the ways for optimizing the billing process was suggested and they are increasing the manpower, responsibility and authority matrix, control chart, training and key performance measures for analyzing the overall department. The study concludes that it is important for billing personnel s to understand the billing process in detail so as to have an effective billing process in healthcare organization. Keywords Billing Process, Insurance Patients. I. INTRODUCTION Billing is the process of generating an invoice to recover sales/service price from the customer. Billing process is the final step in hospital, which is directly proportional to patient satisfaction. Billing plays a vital role in the discharge process, which involves much of clerical work in the billing office and demands time. Billing documents are important for any hospital, its operations encloses clinical aspect, financial aspect and administration for better functioning and decision making. Billing documents are even legally important. The billing department plays an important role, as liaison office between the management and the patients. The hospital billing process is mainly to obtain remuneration for the services and materials provided by hospital to patients. Remuneration is obtained from different categories of people, they are as follows patients, insurance providers and government aided programs. Billing process in the hospital starts from when the patient enters for initial diagnosis till complete treatment. Hospitals information system registers that patients demographic and insurance information. The services availed and materials provided during the hospitalization of patient are documented in patients account. All the various departments post their credit for services provided to patients account. When the discharge instruction of patient is given by physician all the information from patients account is extracted for generation of final bill. Billing process comprise all the activities essential for preparing bill to submit for patients and private providers to obtain reimbursement for the hospital. This process constitutes patients account, bill chart, claims preparing and generating invoice of patients for submission, controlling and monitoring of patients account. As an expansion of billing process is a collection and it is even known as management of account receivables, which comprises follow-up of accounts for collecting due from private insurance providers and patients. The complexity in billing process of hospital which is an outcome of health-care sectors progression. The past records explain about hospital that how medicine changes as year goes and about the evolution of hospital as per revolution. It even explains about the alliance between advanced medicine, progression of hospital and increasing healthcare expenses. Now a day the process of paying the bills have become more concerned than availing services for the patients. Currently it comprises approval and certification, documentation of medical records, coding, agreements, private insurance provider guidelines and various remuneration systems. Due to complexity in the system, there is a requirement of hospital billing professionals who have the proper knowledge of all the above essentials to obtain appropriate reimbursement from patients, government and private insurance companies. 25

2 II. OBJECTIVES The brief objectives of this research are as follows: 1. To study the existing work flow of inpatient billing process in a tertiary care hospital 2. To study the inpatient bill submission process for insurance patients 3. To suggest the ways for optimizing inpatient billing process in a tertiary care hospital III. RESEARCH METHODOLOGY 1. Observational Study was carried to understand the billing process in detail. 2. Inpatient billing process for cash, credit & concession patients are drawn by using flow chart as a statistical tool. 3. The inpatient bill submission process is drawn by using flow chart as a statistical tool and the data related to the same is analyzed in excel. 4. The factors influencing delay in bill submission process is analyzed by using root-cause analysis as a tool. 5. Suggestions are framed as research report for optimizing the inpatient billing process in a tertiary care hospital. IV. REEARCH GAPS 1. On the basis of literature review found that there is a gap to study the hospital inpatient billing process in detail as a separate entity in a tertiary care hospital. 2. To identify the factors influencing delay in billing process of insurance patients in a tertiary care hospital. V. PROCESS MAPPING Billing Process of IP Cash Patient: 26 Figure 5.1: Billing Process of IP Cash Patient

3 Billing Process of IP Credit Patient: Figure 5.2: Billing Process of IP Credit Patient 27

4 Billing Process of IP Concession Patient: Bill Submission Process of Vajpayee Arogya Shree: Figure 5.3: Billing Process of IP Concession Patient Figure 5.4: Bill Submission Process for VAS Scheme 28

5 Bill Submission Data Analysis of VAS Scheme: Table 5.1: VAS scheme month wise statistics of bill submission VAS scheme month wise satistics of bill submission Sl.no Month No of discharge In time submission Submission b/w days Submission after 30 days 1 January February March April May June July August September October November December Total The number of discharge is Maximum in the month of January and even the difference in the time of submission is more in the same month. The number of discharge is Minimum in the month of March and even there is no difference in the time of bill submission for the same. Table 5.2: Month Wise Deduction of VAS as per MOU Month wise Deduction of VAS as per MOU days days Sl.no Month days (30%) >90 days (50%) (5%) (10%) 1 January February March April May June July August September October November December Total The Maximum penalty is in the month of the June and there is no penalty in the month of March. Among all the cases 66% were not implied for nonpenalty, 23% of cases were implied for deduction as per the penalty clause in the MOU and 11% of cases were submitted in the grace period even to which there is no deduction as per the MOU. Figure 6.2: VAS Deduction Chart Penalty is applicable for all the cases which are submitted after 30 days to the trust. Among 23% of penalty cases 5% of cases are imposed to 5% deduction, 4% of cases are imposed to 10% deduction, 7% of cases are imposed to 30% deduction and 7% of cases are imposed to 50% deduction. These deductions are the direct loss to the organization. Root cause analysis for delay in submission of discharged VAS patient bills to the trust: VI. RESULTS AND INTERPRETATION VII. SUGGESTIONS Figure 6.3: Root Cause Analysis Figure 6.1: Percentage Chart of Bill Submission for VAS 1. Increase the manpower in the department for smooth functioning. 2. Responsibility and Authority Matrix for IP Cash, Concession and Credit patients to have a better control on the process. 3. Control Chart/Standard Operating Procedures for Optimizing the Billing Process. 4. Training and education to the staffs. 29

6 5. Set department goals and streamline individual goals with department goals. Include objective measures related to key functions of each job role, track their performance and reward the high/good performers. 6. Key performance measures for evaluating the department. VIII. DISCUSSIONS IX. LIMITATION OF THE STUDY 1. The study is limited up to submission process but there is a scope to study on claims approval and financial impact. 2. A discharge of Medical Oncology and Radiotherapy was excluded as it is submitted only after the complete cycle of treatment. An observation & descriptive study was conducted to understand the inpatient billing process of a tertiary care hospital in detail, since always it is studied along with the discharge process and in the perception of patient satisfaction. Some of the studies reveal that there is delay in billing process of insurance patients and even it is important to identify the factors influencing delay in billing process. Hence the VAS scheme was studied in detail by using flow chart as a statistical tool and by analyzing the one year retrospective data of billing department in the excel. By analyzing the process and data found that there was a delay in bill submission process to the Suvarna Arogya Suraksha Trust and for the same 23% of cases were imposed for deduction as per their penalty clause in the MOU. The reasons for delay in the bill submission process of VAS were analyzed by using root-cause analysis as a tool. There are some of the ways by implementing the same one can optimize the overall billing process in the organization. They are as follows by increasing the manpower in the department, by implementing responsibility and authority matrix for all kinds of IP patients, control chart or standard operating procedures to optimize the process, training and education of the staff and key performance indicators for analyzing the overall department performance. By implementing the above said suggestions one can optimize the billing process of overall department along with the VAS billing and submitting process. It even helps in decreasing the direct loss to hospital by means of deduction. There were some of the limitations during the study are as such the study involves only one particular insurance scheme in detail and it was conducted in a particular tertiary care centre. CONCLUSION Billing process is a part of discharge process but still it is one of the vital functions for maintaining the financial essence of organization. If the billing process system is poorly understood it leads to incorrect documentation, which can result in claim rejection. Hence it is important for billing personnel s to understand the billing process and to have good communication skills in order to have an effective billing process in healthcare organization. REFERENCES [1] Ghose, PATIENT SATISFACTION WITH MEDICAL SERVICES: A HOSPITAL-BASED STUDY. Health and Population Perspectives, 34(4), [2] Kumari, A study on time management of discharge and billing process in tertiary care teaching hospital. Elixir International Journal, 52A, [3] Mehta, Role of discharge planning and other determinants in total discharge time at a large tertiary care hospital. CHRISMED Journal of Health and Research, Vol. 2, issue 1. [4] Somu, G, Hospital Organization, Operations and Planning. Manipal: Sikkim Manipal University of Health, Medical and technological Sciences. [5] Tak, A comparative time motion study of all types of patient discharges in a hospital. GLOBAL JOURNAL OF MEDICINE AND PUBLIC HEALTH, Vol. 2, issue 3. [6] VIGNESHWARAN, S, STUDY ON TURN AROUND TIME OF OUT PATIENT BILLING SERVICES AT SUPER SPECIALITY HOSPITAL / AYANABAKKAM CHENNAI. International Journal in Management and Social Science, 02, [7] Yu Chu, Incremental analysis of the reengineering of an outpatient billing process: an empirical study in a public hospital. BMC Health Services Research, 13: