The Revenue Cycle Management System of Selected Private Hospitals in Quezon City

Abstract

Healthcare, just like education, is essential to our society. The healthcare industry is one of the sectors that are modifying their systems and planning to align with political, regulatory, and societal shifts. As our government fully commits to provide universal health care to the population, concerns about how hospitals, big and small, can be able to cope are on the rise. Billing and reimbursements are some of the significant sources of revenue for hospitals. Thus, effective billing and reimbursement processes play a crucial part in the healthcare industry. Revenue cycle management is the process used by the healthcare industry to manage claims, payment, and revenue. The objective of the study is to assess the effectiveness of revenue cycle management of selected private hospitals in Quezon City. The study adopted a descriptive method of research. The data and information presented herein were obtained from selected private hospitals in Quezon City who are members of the Private Hospitals Association of the Philippines, Inc. (PHAPI). The sampling technique used in the study is purposive sampling. The respondents who participated in the study are a combination of hospital representatives and individual patients or guardians. The researcher used a survey questionnaire as a research instrument. The overall perception of the respondents on the revenue cycle management of selected private hospitals in terms of the front-end process, intermediate process, and back-end process were all "Effective." Among these three variables, the back-end process was highly appreciated, as it had the highest grand mean. This is because most of the respondents are individual patients who are private payors. Thus, they can understand the situation of the hospitals in terms of the billing process, payment posting, and payment options. Meanwhile, data that was gathered from hospital respondents who were grouped according to the number of employees, scope of service, functional capacity, and bed capacity assessment show some significant differences in terms of intermediate and back-end processes. The result implies that the revenue cycle management of a hospital varies depending on its size, scope, and the number of personnel. Larger hospitals tend to have finances to invest in more advanced technology in relation to smaller counterparts. On the other hand, individual respondents' assessment showed a significant difference when they are grouped according to the classification of patients, especially in terms of the front-and back-end processes.