Abstract of Dissertation

Keyword : Hospital Billing Process; Transparency; Estimated Billing; CAPA

Objective : • To identify bottlenecks in the process of both the estimated and the final bill. • To identify root causes of discrepancy between the estimated and final bill. • To provide an action plan to combat with this situation.

Background : Understanding why there is unexpected rise in the final bill and huge difference between the final bill and estimated bill. It leads to dissatisfaction among the patients, subsequently, leads to breach of trust among the patients. Communication is an integral component in the healthcare provision, and this should not be broken.

Methodology : This was a descriptive study with cross-sectional design. A one third of total planned surgeries were taken as sample in the study (100). Data was collected from financial estimation sheet from December 2016 to February 2017 and gaps were identified and OPD prescriptions were reviewed.

Findings : The compliance between the estimated bill and final bill was seen only 23% in December 2016; 37% in January; and it was 43% in February. Root cause analysis was done, and the lack of coordination between the counselors and the surgeons; and documentation gap from consultant side. As a result, the Action Plan was made to define the schedule of charges and to be made more comprehensive. The CAPA was designed accordingly, and again the data were analyzed from March 2017 to April 2017, consequently 92% compliance has been achieved.

Recommendations : In our study, the compliance achieved following implementing CAPA was 92%. The next target is to achieve 100% compliance in the final and the estimated bill for planned surgeries subsequently, for all patients. To study the effectiveness of CAPA, comparative analysis to be done after the collection of complied data for the month of May. Communication and coordination needs has to be maintained.