DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20181767

Case study on reimbursement process and settlement of bills of patients treated under package charges in super speciality public hospital

Ruchi Garg, Neeraj Garg, Abhinav Wankar, I. B. Singh

Abstract


Background: In the Government hospitals, because of constraints of resources, patients are often asked to buy certain items required for their treatment procedure. There is an inadvertent delay in bill reimbursement process due to the cumbersome procedure, which causes dissatisfaction among patients. Thus, it was highly imperative to reduce the reimbursement time and improve the level of patient satisfaction by improving quality of services. The present study depicts modifications initiated to reduce causes of delay and improve patient satisfaction.

Methods: Process mapping was done for different procedures which are carried out under package system at Cardio Neuroscience Centre. All the available documents were analysed from Operation theatre, Wards, ICU, Billing section, Account office, OPD area etc. and Interviews were taken from consultants, nursing staff, staff working at Billing section, Account office etc. to identify causes of delay.

Results: The study helped in improvement in efficiency by 60% percent and reduces the number of resources by 10 percent.

Conclusions: The study helped to increase productivity gains and improve accuracy.


Keywords


Account section, Billing, Delay, Process mapping, Patient satisfaction, Reimbursement

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References


All India institute of medical Sciences. Memorandum No F-3/ Billing Section /95-96,17 july 1995,package Charges for CTVS procedures at AIIMS (CN centre). 1995.

All India institute of medical Sciences. Memorandum No F-4/ Billing Section /2000-2001,31May 2000 package Charges for CTVS procedures at AIIMS (CN centre).

Behera SD. To study the package system of charges at CN Centre and based on the experience explore the feasibility of introducing similar system at AIIMS hospital. 2004.

Harry M Schroeder R. Six Sigma . New York, NY: Doubleday Publishers; 2000.

Tennant G. Six Sigma: SPC and TQM in Manufacturing and Services. Burlington, VT: Gower Publishing Co;2001.

Levtzow CB, Willis MS. Reducing Laboratory Billing Defects Using Six Sigma Principles. Lab Med. 2013;44(4):358-71.

Banuelas R, Antony J. Critical success factors for the successful implementation of Six Sigma projects in organizations. The TQM Mag . 2002;14:92-99.

Antony J, Banuelas R. Key ingredients for the effective implementation of Six Sigma program. Meas Bus Excell . 2002;6:20-7.

DelliFraine JL, Langabeer JR, Nembhard IM. Assessing the evidence of Six Sigma and Lean in the health care industry. Quality Management in Healthcare. 2010 Jul 1;19(3):211-25.

Bucci RV, Musitano A. A Lean Six Sigma journey in radiology. Radiology management. 2011 May 1;33(3).

Panigrahi R. Case study: improving medical bill review cycle time. I Six Sigma. Avaialble at: https://www.isixsigma.com/industries/healthcare/case-study-improving-medical-bill-review-cycle-time/.

Asharani NA, U RK, Nagesha HN. A study to assess the functioning of billing. 2016;(10).

Kumari JV. A study on time management of discharge and billing process in tertiary care teaching hospital. Elixir Int J Mgmt Arts. 2012;11533-5.