Abstract of Dissertation

Keyword : Billing process flow; Sequence Analysis

Objective : Aim: To undertake Sequence Analysis of Billing operations in the Out-Patient Department at Medanta-the Medicity Objectives: • To evaluate the existing process flow of Billing activity in Out-patient department • To identify the areas of concern • To collect, collate, organize and carry out Sequence analysis of the process • To recommend user-friendly IT and Operational solutions in Billing process

Background : : Hospital billing process is very vital for the hospital as well as the patient. It is an amalgamation of numerous sub-processes like registration, cancellation, refunds, discounts, etc. intermingling with departments like Out-patient department, In-patient department, Emergency, and Day care services with different protocols for different payer groups like cash, credit, insurance or Third Party Agent (TPAs). Thus it is imperative to simplify the process for both the staff as well as patient for a better understanding of the same. This project gives an insight into the billing processes for an OPD through Systems Approach and stresses on making a system process dependent, rather than person dependent. The study entails a Descriptive cross-sectional study type with data collection by direct observation of operations and unstructured interviews. It analyses the process by Sequence/Flow Analysis. The existing process was first understood, documented and then analysed. Thus, it revealed two views of the Billing process – one from Operations perspective and the other from IT perspective. Both the process flows were mapped, thereby identifying the ideal scenario, gaps, exceptions, suggestions and recommendations. The data collected was mainly qualitative in nature. However, to validate the concern area of a sub-department, data was collected over a period of 2 months and analysed. Subsequently, a set of suggestions and recommendations were given to make the process more user friendly and effective in terms of reduction of manual work and promotion of automating the process as much as possible.

Methodology : • Type of study - Descriptive cross-sectional • Study population - All patients getting OPD billing done, Billing executives, floor managers of OPD at Medanta, Gurgaon • 100 patients over a period of 1 month • Study area- Medanta – the Medicity, Gurgaon • Duration of Study – 2 months • Type of Data - Qualitative • Technique – Direct Observation of Operations & Unstructured Interviews • Tool- Written Descriptions • Operational Definition: • Operational Process Flow – Billing process pertaining to real time activity on floors by Billing executives o IT Process Flow – Billing process carried out using the system and software like HIS and SAP • Inclusion criteria – o Number of patients getting billing done at OPD o Patients getting billed for Diagnostic services • Exclusion criteria – Patients getting admitted in IPD or Emergency and Day care • Data collection - Primary and Quantitative (4 weeks) • Data entry - Manually • Data Analysis – Microsoft Excel • Sequence Analysis (also known as Flow Analysis) • Some of the easiest problems to miss in a process involve the sequence or flow of information. To discover these opportunities it may require the input from someone who is not part of the process on a daily basis, perhaps even someone who is new to the organization and doesn't already understand "how things are done." A process flow model is extremely helpful in these situations.

Findings : The Problem Areas identified after analysis of the Billing process flow gives the following areas of concern along with the recommendations apart from the ones mentioned along with the process flow are as follows:- Gap Areas 1. Training schedule for the following Users (Operational & IT) not defined •Billing Executives using IT software •Floor Managers 2. Manual prescriptions lead to errors 3. Lengthy process in the system 4. Cancellation and Refunds • Protocol not defined • Manual processing followed

Recommendations : • Training Schedule and Manual for Users should be defined • Electronic prescriptions to be encouraged • Alternate process flows to be tested • Authorization of Cancellation and Refunds to be given to the Floor Managers through the system to reduce and discontinue manual processes eventually