Health
Managing Revenue Leakage in Healthcare
Managing Revenue Leakage in Healthcare Article – Written By: Dr. Jesupelumi Adenihun
Revenue leakage as any unnoticed or unintended loss of revenue from your company – Recvue. Revenue leakage in healthcare according to Srishti is the difference between the amount of payment that is entitled to the healthcare provider versus the amount of reimbursement received.
For clarity, few terms would be defined below.
- Claim: this is a request for payment the healthcare provider tenders to the health insurer (e.g., HMO) for service rendered to the patient.
- Denial: occurs when the insurer refuses to pay for an item or service. If this happens after a claim has been sent following delivery of service, it then becomes ‘claim denial’.
- Revenue cycle (RC): A revenue cycle starts when a patient books an appointment and ends when all claims and payments have been collected by the healthcare provider.
- Accounts retrievable (AR): The amount of money owed to healthcare providers for services and care delivered to patients.
To understand how revenue leakage can play out, the case of Mr. Tanso Justice, a 45year old architect would be considered. (The names or conditions inserted have no bearing to a real person and is solely being used for the purpose of learning).
Mr. Tanso Justice is married to a banker who has insurance covering for their family with JayPMog HMO. He developed abdominal pain which he initially ignored but the situation worsened and became associated with reduced appetite. Realizing his need to see the Doctor., he goes to their provider hospital (Leyden hospital) to get checked.
On arrival, his details are captured, vitals checked and then proceeds to see the Doctor. In the consulting room, the Doctor asks Mr. Tanso asks some questions, examines him and prescribes analgesics and supplements alongside dietary advice. He requested that he get a blood test done and abdominal imaging. Although, at this stage, there is no clear diagnosis yet. The Doctor, in his bid to clear the patients at the waiting area, decided to fill in details of visit at the end of all the consultations.
However, after seeing Mr. Tanso, he realized he was fatigued and decided to go on a break after which he would return to fill in details of the consultations. On returning from his break, he missed certain details on the services he had rendered. He decided to leave out information he was not sure of and deduced the diagnosis for some cases from the prescriptions he sent to the pharmacy.
Having carried out requested investigations, Mr. Tanso picked his medication and returned the following week with his results to see the Doctor. However, this time, the attendant at the front desk captured his name as Mr. Tanko Justice. The Doctor referred him to a specialist as he had an intestinal growth. During this consultation, all details are inputted immediately and a working diagnosis. Only that this time it is under the name ‘Mr. Tanko Justice’ as sent by the front desk.
All this while, Mr. Tanso had made no payment out of pocket and as far as he was concerned, JayPMog HMO was doing a great job. His appointment to the specialist involved further questioning and examination although he could not view his last hospital visit as there was only one documented visit to his name – his first visit. The Consultant requests he get tested for certain tumor markers just to be sure. Mr. Tanso is booked for the above-mentioned test but a call could not be put through to the HMO at that time to confirm if the test was covered. The front desk attendant eventually assumed that this was also covered. A patient had presented with a similar condition from the same HMO and got approval. What she forgot was there are different plans and coverage with HMO.
He gets his test done, returns to the consultant who states there is no problem and gives him a long appointment. All this took place within the space of 3 weeks and the hospital raised claims which received few denials especially the test for the tumor markers. Mr. Tanso is called to pay for the investigation done but insists his HMO should cover that ‘little’ blood test he did in his words. The continuous back and forth on the phone only resulted in a lengthy conversation with no payment.
From the case study presented above, leakage points can already be identified. And no matter how small they seem, they usually result to a large sum being lost over time. Modern healthcare conducted a research across hospitals in Florida and discovered 9% of claims raised are denied resulting in an annual revenue loss of $262 billion. Recent research even shows denial rates have risen to about 11.1% which will continue to be on the rise if not curbed.
The image below by Effy healthcare highlights possible causes of revenue leakages and can also be used to relate with Mr. Tanso’s case.
It is therefore highly imperative that healthcare organizations stay in the black and remain financially healthy. One of the ways of doing this is managing leakage. Failure to do so often results in huge and expensive losses. Some facilities even fold up when they can no longer be sustained. To address the issue of revenue leakage, the first step is to identify and quantify how much revenue is being lost. It would suffice to further identify areas operating effectively and those that need to be worked on.
General improvement measures that can be taken include:
- Automating manual processes. Going digital has been shown to reduce errors and save time.
- Training staff on proper billing and coding.
- Ensuring claims are sent in good time. The longer they take, the more likely they are to get denied.
- All procedures should be confirmed from the insurer in a timely manner to confirm coverage before being done.
- Patients should be communicated with politely yet effectively when the insurer is not covering the cost of care.
- Claim denials should be treated promptly by the team involved when sent.
- Team handling patient care should be constantly reminded of the need for proper documentation as this does a long way in receiving payments due.
- As the need may rise, revenue management should be outsourced for proper revenue cycle management services.
Revenue leakage can be managed. It may be cumbersome attempting to solve all at once. But there are improvements that can be made from time to time in addressing the issues whether simple or complex. Healthcare is dynamic and as such requires the willingness to be dynamic in addressing the challenges.
The inaugural edition of Africa’s Nutrition and Health Summit is set to convene on November 16, 2024, bringing together an extensive network of healthcare practitioners, nutrition experts, agricultural stakeholders, policymakers, and influential leaders from all over the continent under the theme, ” Soil to Wellness: Shaping a United Approach to Africa’s Health.” This groundbreaking summit aims to address the critical rise of non-communicable diseases (NCDs) across Africa through integrative approaches to preventive health, nutrition, and sustainable lifestyle practices.
This movement would explore holistic and practical solutions that unite stakeholders along the health and nutrition value chain, with a critical focus on how surging rates of NCDs like diabetes, hypertension, and obesity can be curbed via sustainable agriculture, improved food quality, and healthier lifestyle choices, to reshape our food and lifestyle culture, thereby laying a foundation for better health outcomes, for generations to come.
A Key Focus on Nutrition and Lifestyle Practices
The summit’s agenda will include panels on integrative approaches to nutrition and preventive health, the dual burdens of malnutrition and obesity, the impact of digital health in preventing diet-related diseases, and the role of sustainable agriculture in food quality. Our holistic approach strives to demonstrate how Africa’s diverse and rich agricultural resources can play a pivotal role in ensuring food security, balanced nutrition, and wellness for all citizens.
Call to Action
The inaugural edition of ANHS is especially relevant to anyone invested in the long-term health and wellness of the African continent. Such stakeholders are not limited to health professionals, nutrition experts, agricultural stakeholders, policy influencers, researchers, food producers, and processors. It is indeed a legacy-defining opening for businesses and community leaders interested in leaving their prints in the sands of policies that would advance health and wellness on the continent.
Participants will gain insights from leading experts and join the cause to champion Africa’s health by focusing on the most essential aspects of disease prevention and overall wellness. Now, more than ever, it is crucial to prioritize wellness at the societal level, addressing the connections between soil health, food quality, and sustainable practices that contribute directly or indirectly to healthy living.
Join us at the inaugural edition of Africa’s Nutrition and Health Summit on November 16, 2024, as we unite to shape a healthier continent – one that intentionally harnesses her resources and expertise to combat non-communicable diseases.
Register here to attend ANHS 2024
For more information, press inquiries, or partnership opportunities, please contact:
RSB
Official Branding Partner of ANHS
Dr. Jesupelumi O. Adenihun (Image: Supplied)
You have likely heard the saying, “You are what you eat,” and it couldn’t be truer. What we consume plays a far greater role in our health than many of us realize. Over time, our eating habits can either support our body’s natural healing processes, leading to improved health and vitality, or contribute to nutrient deficiencies, inflammation, and even chronic diseases.
What this means is, our eating habits over time sets off a series of chain reactions in our bodies that impact our overall well-being. The good news, however, is that by consistently making the right food choices, we can put ourselves on the path to a state of good health and well-being. While this might sound daunting at first, it is often the small, consistent actions that yield the best results. Let’s take a look at 10 simple but effective habits you can begin to cultivate for better health and adopt as lifestyle practices:
- Substitute soda with water: No beverage is more refreshing or beneficial than plain water. It hydrates, cleanses, and confers numerous health benefits.
- Snack on nuts and seeds: When you are craving a snack, go for nuts or seeds, unless you have an allergy. They are nutrient-dense and can also be satisfying.
- Opt for grilled or baked over fried: Choosing grilled or baked foods helps reduce unhealthy fat intake without compromising on flavor. This also helps reduce the risk of developing high cholesterol levels which is a cardiovascular risk.
- Enjoy homemade smoothies over sugary drinks: When time permits, make homemade smoothies making use of reliable recipes. If you are short on time, consider vendors who provide fresh, nutrient-packed options.
- Practice mindful eating: Mindful eating means being fully present during meals, savoring each bite, and listening to your body’s signals. Eating mindfully is a game changer for a lot of people.
- Be well-informed about what you consume: Whether it’s food or drinks, it is essential that you stay conscious of what’s in your food and drinks. Many packaged products contain hidden sugars that the body doesn’t exactly need. Always take a moment to check the ingredients.
- Add more vegetables to your plate: Think beyond the usual veggies—some varieties exist which also depends on your geographical location. Be open and willing to explore new options and add color to your meals.
- Prioritize lean proteins: Not all proteins are created equal. Make lean protein choices and consider plant-based options to support your overall health.
- Use natural spices over salt-laden seasonings: High salt intake is known to be a contributor to heart-related conditions like hypertension. Opt for natural herbs and spices to add flavor without carrying on health risks.
- Stay physically active: Find an activity you enjoy and can commit to, whether you are at home or on the go. Consistency is key. Also seek the counsel of a coach if you need to.
Remember, true wealth lies in your health. Let each meal choice you make be a step toward a healthier, more vibrant life. Eat to wealth, health is wealth.
Written By: Dr. Jesupelumi O. Adenihun (Nutrition Coach, Preventive health care specialist).
Menstrual health is not just about periods; it’s about breaking the cycle of exclusion and empowering the future of Africa – one girl at a time.
Empowering women and girls who menstruate worldwide starts with breaking the silence around periods. Eno, a 14-year-old girl from a remote community in the south, shrinks when her period arrives each month. Shame and fear are a constant part of her experience. “At school, whispers follow me. They call me ‘dirty’ because I can’t afford pads. I use the white piece of cloth my mother gave me and the extra layer of pad I had sewn on our neighbor’s machine using pieces from his shop.” Eno’s story, though heartbreaking, is far from unique. Across Africa, millions of girls and women face a hidden crisis: period poverty.
Period poverty refers to the inability to afford and access menstrual products, sanitation and hygiene facilities, and education and awareness to manage menstrual health. Globally, more than two billion people around the world menstruate monthly.
Menstruation, a healthy and natural biological process continues to be shrouded in silence and stigma across many parts of Africa. This silence perpetuates a cycle of neglect and exclusion, where the menstrual health needs of women and girls are ignored, leading to significant physical and mental health issues.
Daily, women and girls are unable to afford sanitary pads, forcing them to resort to unhygienic alternatives like old rags, leaves, old clothes, cotton wool, toilet paper, newspaper, and make-shift hygienic pads. This lack of access not only affects their physical health but also their mental well-being, as they experience anxiety, shame, and isolation during their menstrual cycles. With limited to no access to safe water and sanitation to manage their menstrual health and hygiene, these women and girls who cannot afford menstrual products do not live well within their rights and freedoms as their menses interrupt their day-to-day flow.
Human-Centered Stories
To truly understand the impact, we must listen to the voices of those affected. Nike, a 15-year-old girl from a rural community in Ogun State shared, “I have to stay home when I have my period because I don’t have pads. I miss out on school and feel ashamed.” Rukkayat, another young woman from a community in Abuja stated, “The stigma around menstruation is so strong that I can’t even talk to my teachers about it. It feels like a dirty secret. I feel dirty walking around my school. So, I’d rather stay at home when I’m on my menses to endure the pain and take care of myself.” These anonymous quotes reflect a common reality for many girls and women across Africa, highlighting the urgent need for change.
Addressing Stigmas and Period Poverty
Period poverty stems from persistent stigmas around menstruation. These stigmas include the belief that menstruating women are impure, leading to their exclusion from everyday activities and social interactions. Such beliefs not only undermine women’s confidence but also reinforce gender inequality. Periods, already a source of physical discomfort, become a breeding ground for anxiety, shame, and isolation. This can lead to depression, decreased self-esteem, and a reluctance to seek help. The link between menstrual health and mental health is undeniable.
To combat these stigmas, sensitization initiatives, and project outreaches need to provide menstrual products and education. These programs will empower girls with knowledge and resources, breaking the silence and changing societal attitudes toward menstruation.
Breaking the Cycle: Investing in Solutions, Empowering Futures
So, how can we bridge the gap between menstrual health and mental health by showing one can’t do without the other? By recognizing that menstrual health is intrinsically linked to mental well-being, we can create holistic approaches that address both.
- Combat Stigma Through Education: Open conversations are key. Educational programs that address menstrual hygiene and dispel myths can empower girls and communities. Schools and communities should provide comprehensive menstrual education that includes mental health support.
- Invest in Sustainable Solutions: Supporting the development and distribution of affordable, reusable menstrual products is crucial. Access to menstrual products should be seen as a basic human right, and efforts should be made to ensure that all girls and women have the necessary resources.
- Build Sanitation Infrastructure: Safe and private sanitation facilities in schools and public spaces are essential for dignity and hygiene management.
- Champion Advocacy: Investing in menstrual health advocacy at the local and national level can lead to policy changes that prioritize girls’ needs. From providing dignity kits to advocating for safe and private facilities, menstrual hygiene management is crucial for their well-being and development. Through advocating for women and girls, we can ensure every girl has the knowledge and resources she needs to thrive.
By investing in menstrual health, we invest in a future where girls like Eno, Nike, and Rukkayat can access education, participate fully in life, and thrive. Through increased conversations and heartfelt advocacy, the Going North Project initiative is addressing the urgent need for quality healthcare, education, and the eradication of period poverty through targeted outreach programs.
The Going North Project aligns with the Sustainable Development Goals (SDGs) of Education, Health, and Gender Equality, which are crucial for fostering a brighter future and empowering girls – one at a time.
Let us address the urgent need for accessible menstrual health resources and education, highlighting how this issue impacts individuals globally. This advocacy inspires and reminds us that menstrual equity is essential for a just and healthy world. Together, we can break the stigma and ensure menstrual equity for all.
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