Different Billings for Same Procedure.
Same procedure in same hospital but different billings for two different patients.
I am managing 10 hospitals in Their 2 and tier-3 cities of India. In india, 80% of services are provided by private players and Govt. contribution is limited to 20%. One of the biggest challenges, I am facing is of billing. There are 100 odd private insurance companies & TPA and around 25 to 30 organisations insuring working public under social security schemes. Every panel has its own billing structure and there are lot of different bundled payment packages for the same procedure in the country. It becomes really tough to bill the patients according to the organisation in which patient is covered. Although, there are a lot of software available for Billing but again there are changes in billing according to category of hospitals too . Many a times, Payers deny for the payments to providers even after bill correction.
Well, Internet died and lost my response which was surely the answer to all your problems. =). Anyway, I’m unclear whether the problem is that the software is unable to handle the differing charges or if the goal is more one of management, trying to reduce variation for the purposes of managing operations and planning. Unclear what is behind the payer denials or if it is arbitrary?
It would seem that would need revenue steering committee w representation across the hospitals focusing on one group of CPTs/bundles at a time to try and gain alignment and then bring in payer representation, though w so many private payers that will prove to be a slow and challenging road..
We have the similar problem in Malaysia too that leaves a lot unpaid and collection is constantly an issue. Ours remains more complicated as we do not have the bundling system. We tend to have to go back and forth replying deferment letters from the payers with justifications from our doctors, and more often than not, payments are denied.
I agree with Sri that it would seem beneficial to ensure bundles are carefully structured with the payer’s involved in the process. However, for a tertiary care hospital, it can be gruelling process.