ANALYSIS OF INPATIENT RECEIVABLES MANAGEMENT INSURANCE COVERAGE AT XYZ HOSPITAL

Abstract

This paper explores the management of inpatient receivables under insurance coverage at XYZ Hospital, using the theory of constraints as a framework. Employing a qualitative, descriptive approach, the study aims to identify and analyze key constraints within the receivables management process, covering stages such as acceptance, account arrangement, verification, billing, and closing. The analysis focuses on internal hospital factors, including human resources, standard operating procedures (SOPs), computerized systems, and hospital facilities and infrastructure. Findings highlight significant limitations, such as a shortage of skilled personnel, lack of established operational standards, suboptimal utilization of the MyAccounting system, and inadequate facilities and infrastructure that delay the insurance collection process. To streamline receivables management, XYZ Hospital requires comprehensive follow-up measures, including facility upgrades, infrastructure maintenance, workload analysis, targeted training, clear delegation of authority, defined job descriptions, ongoing monitoring and evaluation, and the establishment and socialization of SOPs to guide staff in effective implementation.