Propuesta de estrategias para reducir las glosas relacionadas con las tarifas de la E.S.E. Hospital Regional de García Rovira durante el año 2023

Abstract

The study "Proposal of Strategies to Reduce Billing Discrepancies Related to Tariffs at the ESE Hospital Regional de García Rovira during 2023" focuses on a critical financial issue in the healthcare sector in Colombia: billing discrepancies. These discrepancies, which are objections to the amounts billed to insurers, have significantly impacted the hospital's revenues, jeopardizing its economic sustainability. The deductions applied by insurers arise from billing errors, regulatory interpretations, and discrepancies in the application of contractual tariffs. To address this problem, a thorough analysis of the billing processes, documentation, and staff training was conducted. The results revealed that the main deficiencies stem from a lack of training on current regulations and errors in service coding, leading to inconsistencies in issued invoices. Additionally, it was found that the billing process lacks automation, increasing the likelihood of human errors. In response to these findings, the study proposes several strategies to reduce the incidence of billing discrepancies. It suggests automating the billing process to decrease coding errors and facilitate the review of amounts billed. It also recommends strengthening staff training on regulations and updated information systems, as well as implementing quality controls at each stage of the billing process. These actions could significantly improve the hospital's financial stability and optimize its administrative management.