Payment from third parties.
WHAT SCHEMES PROVIDE
Patient volume Predictable, if delayed, payment
WHAT THEY COST
Lower rates than direct payment Administrative burden Delay Rejected claims
WHAT TO ESTABLISH BEFORE ENROLLING
The tariff for your services What is covered and what is excluded The claim process and its deadlines Payment timelines, actually experienced What documentation is required
HOW TO ESTABLISH ACTUAL PAYMENT TIMELINES
Ask other facilities.
WHY
Stated and actual timelines differ.
WHAT TO CALCULATE
Whether the tariff covers your cost of providing the service.
WHY
Some tariffs do not, and volume makes it worse.
WHAT CAUSES CLAIM REJECTION
Incomplete documentation Missing authorisation Services outside cover Late submission Coding errors
WHAT TO ESTABLISH
What authorisation is required before providing care.
WHY BEFORE
Care provided without it is frequently unpaid.
WHAT TO BUILD
A process ensuring every claim is complete before submission.
WHAT TO TRACK
Claims submitted Claims paid Claims rejected, and why Days to payment
WHAT REJECTION PATTERNS REVEAL
A fixable process problem.
WHAT TO DO ABOUT REJECTED CLAIMS
Appeal them, within the deadline.
WHY
Many are recoverable and most are abandoned.
WHAT TO ASSIGN
Responsibility for claims, to a named person.
WHAT TO MONITOR
Outstanding balances by scheme.
