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.
COVAX surpasses 1.5 billion COVID-19 vaccine deliveries
Today, COVAX has surpassed the milestone of 1.5 billion COVID-19 vaccines delivered around the world, following a shipment of 2.26 million doses of the Johnson & Johnson vaccine to Tanzania. A little over 15 months since its first international delivery to Ghana, COVAX has now shipped COVID-19 vaccines to 145 countries across the world.
Nearly 90% of these have been fully funded doses delivered to lower-income countries supported by the Gavi COVAX Advance Market Commitment (AMC). COVAX is the major supplier of COVID-19 vaccines in low-income countries and humanitarian settings. As the largest and most complex global vaccination effort in history, COVAX’s work has helped raise the proportion of people in 92 lower-income countries protected by a full course of vaccines to 46% on average.
Dr. Seth Berkley, CEO of Gavi, the Vaccine Alliance, which manages the COVAX Facility and the Gavi COVAX Advance Market Commitment (AMC), and leads on procurement and delivery at scale for COVAX, comments on this milestone: “This is a significant milestone for COVAX, set up as an unprecedented global collaboration during the worst public health emergency in a hundred years, but more importantly, we are proud to have contributed to the incredible achievements of lower-income countries, who have administered nearly 4 billion doses of COVID-19 vaccines in a truly historic global rollout.
Tanzania is a fitting example of the hurdles that have been overcome and the challenges that remain: the pandemic is not over, and we must remain committed at all levels to pushing coverage rates higher, focusing on ensuring those at high risk are fully protected. With plentiful global supply now available to support this effort, the next 3-4 months are crucial. We call on countries to set ambitious targets backed by concrete plans for implementation and on all partners to provide countries with the resources needed to accelerate and expand national strategies.
COVAX remains committed to working with partners to ensure lower-income countries can access both vaccines and the support needed to turn these vaccines into vaccinations.”
Nigerians in the diaspora reduce their lifespan by working over 55 hours a week – Adaku Efuribe
As a Nigerian living in the diaspora, I have observed some character or culture flaws most Nigerians always exhibit different from the culture of their environment or community.
In the UK, employed workers always look forward to going on holiday, weekend break or some sort of fanfare. Nigerians are always known to work for 52 weeks in a year with little or no planned holiday.
Most of us use our annual leave allowance to attend burials, traditional marriage, parties also known as ‘owambe’, and travel home for Christmas and Easter holidays. We all know that anytime we travel back to Nigeria for any ceremony, we are not actually having a proper holiday. Holiday is different from visiting family and friends.
Out of about six weeks annual leave, bringing out at least a week for a planned holiday which would entail 100% relaxation and fun is not asking for too much. I’m not saying people should not visit their loved ones back home, but we have to know the difference. Holiday is necessary to refresh one self and renew energy so that we can destress and improve our mental health and overall wellbeing
Most of us work for 8,9,10 long hours a day. Some of us even work for over 55 hours a week and this is not healthy.
The WHO has advised that working over 55 hours a week can reduce one’s life span. According to WHO, long working hours are killing hundreds of thousands of people a year, according to the World Health Organization (WHO). The research found that working 55 hours or more a week was associated with a 35% higher risk of stroke and a 17% higher risk of dying from heart disease, compared with a working week of 35 to 40 hours. The study, conducted with the International Labour Organization (ILO), also showed almost three quarters of those that died as a result of working long hours were middle-aged or older men. Often, the deaths occurred much later in life, sometimes decades later, than the long hours were worked.
So why do Nigerians living in the diaspora like working till they drop…well the reason is an offshoot of a typical Nigerian problem caused by economic hardship. People see working as a means of escaping poverty back home so when they find themselves abroad, they forget they are mere human beings who can break down. Part of healthy living entails bringing out time for relaxation. Travelling home for Christmas, Easter or attending one ceremony or the other is not relaxation. Once every year, stop working, go somewhere quiet…. Rest, sleep, explore and just do nothing.
Nigerians in the diaspora work so hard year in year out only to die of stress related illness afterwards. When you are sick. Your employer would replace you within days…
There is a place for play, your annual leave is for rest and holiday. Please create at least 10 days out of your annual leave entitlement for a planned gateway holiday. You don’t have to travel very far; it could just be a staycation in another city.
Like they say in Nigeria, problem no de finish, please look after yourself.
Article by Adaku Efuribe (Health Promotion Ambassador)
Gricd and HaulTrac Partner to Deliver Essential Healthcare Commodities across Nigeria for USAID
Gricd, a cold chain technology company that uses the Internet of Things (IoT) to enable last-mile delivery of temperature-sensitive products, has partnered with Haultrac, one of Nigeria’s leading logistics companies, to support the delivery of essential healthcare commodities to all 36 states of the country. As well as the Federal Capital Territory, Abuja on behalf of USAID.
The partnership is an indefinite quantity agreement that includes the delivery of commodities. Such as medicines, rapid diagnostic test kits, laboratory reagents and consumables. As well as other related health and non-health commodities across the country. Gricd’s cutting edge technology will be leveraged to ensure that these commodities reach their final destinations in their most effective state and the startup will work with Haultrac, USAID and other partners to support the storage and transportation of agreed commodities between agreed locations.
Using Gricd’s Real-Time Data Loggers and Enterprise Monitoring Software, all parties will be able to guarantee the quality of these commodities during storage, transit and distribution to the end-user. The partnership will also include long haul and last-mile delivery of commodities dispatched and received from central and regional warehouses to cold storage facilities in Abuja, Jos, Ogba (Lagos State) and Oshodi (Lagos State). As well as from regional distribution centres to health facilities or other designated service delivery points supported by USAID.
Commenting on the partnership, Oghenetega Iortim, CEO and founder of Gricd, said: “Inability to keep temperature-sensitive medical commodities within required temperature range leads to waste of life-saving medication, sometimes loss of life. We are excited to be working with Haultrac and USAID to ensure the safe delivery of these essential commodities across Nigeria and make it easier for all parties to do business with confidence.”
Segun Adeoye, CEO of Haultrac also said that: “Transporting temperature-sensitive commodities over long distances in a country like Nigeria can present many challenges. However, with real-time monitoring, we can move these commodities with confidence and take proactive steps to reduce wastage and maximise the value of these commodities.”
Gricd offers a range of IoT-enabled solutions that deliver reliable and consistent temperature monitoring and data logging. Especially during storage, transit and distribution of temperature-sensitive products such as vaccines, insulin and food. By enabling automated, real-time monitoring, Gricd makes it easier to guarantee the safety and security of products and assets. The startup already works with some of the leading pharmaceutical manufacturers and food companies in Nigeria and across Africa to monitor the quality of food and pharmaceuticals. Supporting them to realise more than $193 million in savings and successfully monitoring more than 12 million temperature-sensitive items.