Managing any field is never a simple task. A lot of care is needed with every detail, which is no different for health plan operators, who need to do their best to manage healthcare costs well. In this post we will explain the challenges encountered in the medical bill management process and how to optimize all processes in this field!

We know that operators need to follow some rules that other areas should not worry about.

But it's a little difficult to know what to do without knowing the challenges encountered in the medical bill management process.

For this reason, we have prepared complete material that will highlight the main challenges encountered and what you can do to overcome them.

So, let's go!!!

Be up to date with all ANS requirements

Regulatory bodies are essential for businesses throughout Brazil to function effectively. It is the ANS (National Supplementary Health Agency), linked to the Ministry of Health, which controls and supervises health plans.

It is essential that this agency exists, with the purpose of ensuring public interests and promoting health in the country. But it is very complicated when all ANS requirements are not followed.

For this reason, one of the challenges encountered is to pay attention to keeping everything correct in your business so as not to end up with the IDSS (Supplementary Health Performance Index) falling and having to pay fines that greatly harm your financial health.

Furthermore, the lower the index of your plan, the lower its visibility in the market, therefore, the business will have fewer beneficiaries, less profit and consequently more problems.

Therefore, it must be recognized that, as in other areas of the market, customers are responsible for keeping the business running.

Therefore, beneficiaries must always be satisfied with the health plan, after all, that is what the supplementary health performance index is for.

Well, now that we've seen one of the challenges encountered in the medical bill management process, let's move on to the next one.

Stay tuned!

Be transparent with beneficiaries and providers

There are many lawsuits targeting health plans across the country. To give you an idea, the state of São Paulo alone, analyzing a period of 8 consecutive years (from 2011 to 2018), had an increase of 387%.

It is more common for the processes to come from beneficiaries who have somehow felt harmed by the company. Therefore, transparency with them is extremely important.

As Brazilian bureaucratic processes are very demanding, sometimes customers have many doubts regarding the information provided among that pile of paperwork.

Therefore, it is essential that health plan operators are transparent with beneficiaries, that is, they must go through each part of the contract in detail, ensuring that they are truly aware of their benefits.

But transparency must not only be maintained with beneficiaries, service providers also need to be aware of all details pertinent to their activities.

Many operators, on purpose, fail to explain the famous between the lines, which usually contain valuable information, both for beneficiaries and service providers.

In the end, having processes going on under the name of the operator can harm the management of medical bills in a few different ways, as money will be spent on processes and declining popularity, for example.

So, pay close attention to overcome this challenge, I bet you will succeed if you plan well.

But there is still more content for you to improve your business operator management. See below!

Do daily audit

The audit process is important for all businesses, especially in this time of Covid-19, as it is what guarantees that all accounts are within planning and what prevents financial deficits.

However, it is also a challenge to be overcome, as the audit requires a lot of care from trained professionals and business organization.

It is no different in medical operators, however, it is recommended that audits be carried out daily.

The number of patients who use the health plan per day can be quite high, so a series of information, values and approvals are open daily and need to be checked to see if they are consistent with business planning.

So, make sure that the professionals who are handling the audit are careful and remember, overloading them can create difficulties in the process, so ensure that the number of auditors does the job.

Shall we continue following? Below, learn more!

Use a digital solution

Directly linked to the last challenge, using a software Automating account management audits could be the solution you've always been waiting for to facilitate countless healthcare provider processes.

We can, first, think about the physical quantity of documents that are accumulated per day and that could be avoided with an efficient management system. It's good for your business and the planet, isn't it?

Furthermore, it would facilitate both the operator's work (mainly auditors) and the work of service providers (doctors, nurses, nursing technicians and other professionals).

The purpose of this software is to facilitate those various processes that tend to be very time-consuming and laborious in the daily lives of health plan operators.

In this way, making the company healthier, with the ability to improve results and benefit all workers involved, both at the operator and in hospitals, clinics, nursing homes, among others.

For example, one of the first steps taken by service providers when carrying out some type of medical procedure is to send the authorization request to the operator, which must be approved before it can then be carried out.

Afterwards, anyone who is familiar with the processes between service providers and the plan operator knows that releasing payment is one of the last steps, which we can advance with the help of a digital solution.

Well... we are very happy if you followed this text to the end, and we hope we have helped you learn more about the challenges encountered in the medical bill management process, and what can be done to avoid them and maintain your plan provider. health always healthy. Take the opportunity to get to know SAUDI, an intelligent and integrable system that manages all medical bills for your health plan operator. Reduction of glosses, costs and much more transparency between operator X suppliers. O SAUDI It will surprise you and bring significant results in just a few months of use.