Value Chain for Patient Billing Process

5 The as-is Patient Billing Process The billing process of SHH starts when all healthcare services to the patient have been delivered. Before a bill can be made, the nurses and doctors (medical staff] need to record the medical treatments and supplies applied to the patient. Afterwards, this is communicated to the reception desk, who produce the bill. One bill covers one visit of a patient, but the bill might be paid by different entities. Reception staff must then check the patient's coverage from SHH's patient database. All or part of the payment may be covered by insurance (for domestic patients only), and this needs to be billed to the insurer. 1f SHH has a contract with the insurer, the reception will use a fast online failsafe system to submit the bill to the insurer. If no contract exists, the billing process must be abandoned with an appropriate message escalated to request a contract issuance {another business process within SHH). Otherwise, international patients may use a guarantor agency, which is billed instead of the patient. If none of the above apply, the patient may directly be billed the entire amount. Sungical procedures may be intensive and require a recovery, thus any bills to patients are sent at least one month after their medical procedure finishes. Alter any bill is sent, if the entire outstanding balance is received by an SHH payment ofcer, the process is completed. If the insurer or guarantor agency does not cover all costs and only returns part of the payment, the patient will be billed the remaining balance. If no payment is received to SHH from any party after 14 days of a bill being sent, a rst reminder will be sent by the payment officer. If again after 14 days no payment is received, a second reminder will be sent with an added fee. All bills and reminders to patients contain an invitation to get in touch in case of hardship. At any time during the process, the patient can reply with a hardship request. An SHH receptionist will then do one of the following: - The bill amount will need to be discounted if the patient's situation is manageable [so the receptionist signals this message to the payment ofcer), or - The bill will be cancelled if the patient's situation is too severe [and the process ends]. If in any situation two reminders are missed, the payment ofcer calls the patient urgently to arrange payment (leaving a voicemail upon no pickup). That acts as a 3rd reminder, giving the patient another 14 days to get back with the bill payment. If the patient still does not, then the hospital proceeds with credit collection, which is not outsourced due to the sensitive nature of the bills. The credit collection might eventually lead to a court case being led by the legal staff of SHH