Financial management of health plans is a delicate process. From prospective risk analysis and budget planning to auditing, several steps must be strictly followed; After all, the product offered often has a high cost or is demanded on a large scale. To maintain the financial health of a health plan, a medical billing system can help.
After all, many steps in financial management also mean many possibilities for errors. Doing this process manually or fragmented is a considerable risk factor when it comes to medical auditing. Below we will talk a little more about how a medical billing system can help in this process. Let's go?
The relevance of the audit
Few managers doubt that auditing health plans is necessary: after all, if it is ineffective, spending tends to be excessive and uncontrolled, causing the company's financial health to deteriorate. However, it is not uncommon for auditing to be done routinely and not receive the necessary attention. What is its real impact, after all?
Let's look at the data: according to the Institute of Supplementary Health Studies (IESS), fraud in the area has a devastating cost. In Brazil, its financial impact reaches R$ 20 billion for health plans, and it also affects patients — the cost of medical procedures rises, on average, by a third due to this practice.
This shows us how important monitoring is for health plans. This practice not only leads to reduction of unnecessary costs to operators — which, in itself, would justify its importance, but also directly impacts patient satisfaction with the service and, consequently, their retention in the system. Therefore, it deserves our attention.
Making a healthy agreement
O audit environment It is often a reason for friction between the operator and its service providers. Clinics and hospitals, even if well-intentioned, can feel overwhelmed by large requirements or very complex audits. Therefore, it is necessary to reach a middle ground that is both efficient and health plan management attractive to its providers. This can be a challenge.
To resolve this dilemma, transparency and direct, clear dialogue are the best options. This is valid for any agreement in the business environment: take Nubank for example, which comes showing formidable growth Throughout the national territory. One of the reasons for its success is a simple and honest relationship with the customer. This is an analogy that can very well be transferred to the relationship between a health plan operator and its providers.
Transparency as the key to success
As we mentioned, transparency is essential when contacting clinics and hospitals. It is useful for both sides, because it is possible to clearly understand the nomination criteria and the audit of procedures and materials. This way, both sides of the agreement can plan in advance and avoid surprises.
Transparency is so important that IESS itself has already mentioned it as one of the key factors for reducing medical errors. It is one of the main causes of dissatisfaction among health plan service providers — they often complain that they do not know the audit criteria or that they are too subjective or unclear.
Using technology to your advantage
In a context of need for clarity of criteria and automation of tasks, a practical solution is the medical bill system. It automatically audits health plan accounts, eliminating human errors and making the process clearer for both sides.
There are several purposes for its use. The medical bill system operates from requesting authorization to releasing payment, facilitating this entire process. It avoids unnecessary expenses, rework and communication friction, improving the management of assistance resources. Check out some of its benefits below!
Clarification of contractual rules
A medical billing system makes all contract details clear to health resource providers and plan managers. It can be accessed by both the supplier and the manager, bringing more authority to your company. Understanding the clauses and rules makes the entire process more transparent and facilitates communication.
Longitudinal resource tracking
With automated control of financial data, it is easier to plan and control unnecessary expenses. A medical billing system stores this data securely and accurately, once again preventing human error. It is possible to check the growth trend, the increase in expenses and the allocation of resources in a single click. This way, financial management becomes much easier.
Ease of sharing documents
In the relationship between the health plan and its suppliers, it is essential that documents are consulted quickly. Tables of therapeutic and diagnostic procedures, for example, should be on hand for both sides. The system facilitates this query and also provides greater compatibility, working on various computers and gadgets.
THE SAUDI
If you are interested in the benefits that a medical billing system can bring, SAUDI could be your solution. It is a specific system to improve the financial health of supplementary health plan operators: with it, you can achieve simpler and more direct contact with your suppliers, improving the audit process and making your work easier.
The results are seen within a few months of using the program — with process automation, it is possible to better plan your resource allocation and create a budget with much more precision. Our system operates throughout the entire process for medical procedures, leaving you free to plan in other areas of health management.
If you want to find out more about our medical billing system, why not get in touch with us? We look forward to getting to know you better and will be happy to answer your questions regarding our software. Don't be left behind and increasingly improve the financial health of your health plan provider!
