Hospital Revenue Cycle and Cost Control

Where hospital margin leaks

Unbilled procedures, delayed HMO claims, rejected claims and uncontrolled consumables are the four most common leaks.

Tighten the revenue cycle

• Capture services at the point of care, not from case notes later
• Verify insurance eligibility before treatment where possible
• Submit claims within days and track rejections by reason
• Reconcile claims submitted, paid and outstanding monthly

Control consumables

Store issues should be requisition-based and matched to procedures performed. Periodic stock counts of high-value items are non-negotiable.

Departmental reporting

Report contribution by department — outpatient, theatre, laboratory, pharmacy — so investment decisions rest on evidence.