Process Improvement in OPD billing by observing Billing Errors and thereby increasing patient satisfaction

A Project Report On
“PROCESS IMPROVEMENT IN OPD BILLING BY
OBSERVING BILLING ERRORS AND THEREBY
INCREASING PATIENT SATISFACTION”
Columbia Asia Hospital, Pune
Submitted By
Dr. Angela Kaul
12040141081
Under the guidance of
Mr. Naveen Kumar
Finance Manager
Columbia Asia Hospital, Pune
Submitted to
Symbiosis Institute of Health Sciences, Pune
(Symbiosis International University) in partial fulfillment of the requirements for the
award of the Degree of Master of Business Administration 2013-2015)

STUDENT DECLARATION
I, the undersigned, hereby declare that this project entitled ―
“PROCESS IMPROVEMENT IN OPD BILLING BY OBSERVING BILLING ERRORS
AND THEREBY INCREASING PATIENT SATISFACTION” is my own work, which
was carried out at Columbia Asia Hospital, Pune as a part of my Summer
Internship Project. The duration of the project was from 7th May, 2014 to 7th
August, 2013.
I also declare that all the sources I have used or quoted have been indicated or
acknowledged by means of complete references.
_______________________ _______________________
Dr. Angela Kaul DATE

ACKNOWLEDGEMENT
This acknowledgement is a gesture of gratitude toward all those people who were
the driving force in the successfulcompletion of the project.
I would like to convey my earnest appreciation to Mr.Naveen Kumar, Finance
Manager, Columbia Asia Hospital, Pune, for giving me this opportunity to carry
out my project in this esteemed organization.
I take this opportunity to express my profound gratitude and deep regards to
Mr.Prashant Mahantgol ,Mr.Vishal Kadam, Mr.Rajesh, Mr.Ravikiran B.A
Mr.Naazzir Shaikh and Mr.Sameer Desai for their exemplary guidance,
monitoring and for providing me with the necessary information and assistance
throughout this project.
Very importantly, I would like to thank Dr.(Col) Vijay Deshpande (HOD-
HHCM) of Symbiosis Institute of Health Sciences for providing us this opportunity
to undergo a summer internship program. Also, for their good wishes and blessings
for this project.
Last but not the least, my heartfelt gratitude to my parents, family and my friends
for their constant encouragement, support, help and valuable advice to make this
project a success.
Dr.ANGELA KAUL
MBA-HHCM (2013-2015)
Symbiosis Institute of Health Sciences
Pune, Maharashtra.

PROCESSIMPROVEMENTIN OPD BILLING BY OBSERVING BILLING
ERRORS AND THEREBYINCREASING PATIENT SATISFACTION
ABSTRACT
For the improvement of quality and increment of efficiency a study was carried out
in the billing department of the Columbia Asia hospital, Pune. A time and motion
study was conducted by taking 50 samples to study the time requirement and the
delay in the process. Supported by the above mentioned study, observations and
access to various data from the hospital authority, the problem areas in the process
were found out to be non-value adding steps in the process and error rate in the
processing of billing and certain adaptations in the system leading to wastage of
resources.This study was done to thereby increase patient satisfaction by studying
the same in current scenario.
Good health is the foundation of a happy, productive and rewarded life. More
health problems can be managed more effectively if detected early. The modern
lifestyle today symbolizes excessive stress and strain, extended working hours,
irregular eating habits, late night weekend parties, and inadequate rest. Coupled
with high levelled pollution, these factors are bound to cause health related
problems, and physical, mental and psychological disorders. With today’s
sedentary and unhealthy lifestyle, man is getting prone to number of ailments and
diseases. Diseases like diabetes, hypertension, oral and lung cancer and
osteoporosis can directly be attributed to the modern way of living.
To meet the growing demands of the competitive world, most of us tend to ignore
our health until we are compelled to confront a medical complication. To cope up
with a rising risk of the medical disorders, health monitors have become
mandatory. Not only are the chronic conditions projected to be the leading cause of
disability throughout the world by the year 2020; if not successfully prevented and
managed, they will become the most expensive problems faced by our health care
systems. In this respect, chronic conditions pose a threat to all the countries from a
health and economic standpoint. Many diseases can be prevented, yet health care
systems do not make the best use of their available resources to support this
process.

AIM:
 To Increase overall satisfaction rate of patients at the hospital OPD
OBJECTIVE:
 Make the patients flow easy
 Reduce Waiting time during billing at the OPD
 To improve Quality and safety
 Create an environment that promotes high quality patient care
 To understand the billing process ofthe Hospital
 To find out the bottlenecks in the process and the problem areas
 To find out the non-value adding steps in the process
 To find out non-productive practices in the system
 Recommend solutions to increase the process efficiency
LITERATURE REVIEW
GLOBAL HEALTHCARE INDUSTRY:
The global healthcare services market is forecast to reach $3 trillion by 2015,
according to research from Global Industry Analysts. Investment in sectors such as
home healthcare, healthcare IT and tele-health are expected to continue fuelling
market expansion. Due to the world’s aging population, the demand for home
healthcare is likely to continue climbing over the years to come.
 The healthcare services industry is labour intensive and overburdened in
many regions, making tele-health and healthcare IT attractive options. With
medical technologies continually developing, these options are proving beneficial
to patients and the overall healthcare system.
 The global healthcare services market is impacted by government legislation
and incentives. Spending in the sector continues to climb, partly due to the
availability of new drugs, higher health insurance premiums and advanced
technology services. Demographic profiles also play an important role in the
industry, with demand created by lifestyle-related medical conditions. In addition,
an aging population means that age-related health conditions continue to create
demand.
 Spending on home healthcare is forecast to continue rising as elderly and
terminally ill patients opt for the ease of receiving healthcare at home rather than in
hospitals or clinics. As with many other industry sectors, information technology is
also affecting the area of healthcare services, with many healthcare bodies

concentrating their efforts on setting up or enhancing their electronic medical
records systems, electronic health records and personal health records.
Key MarketSegments
 The global telemedicine market is expected to record close to 20% yearly
growth between 2010 and 2015, according to research from RNCOS. The sector
facilitates interactive healthcare through telecommunication and technology.
Market expansion is driven by the need to cut costs within the medical sector, ease
of penetration and wider availability of equitable healthcare. Increasingly common
conditions, such as diabetes, are also fueling telemedicine market growth. The
sectorbenefits from rising private and state sponsorship.
 The global healthcare and home monitoring market continues to expand,
largely due to patient ease and comfort, cost cutting in the healthcare sector, and
technological developments. Berg Insight estimates the number of home
monitoring systems with integrated communication capabilities will record 18%
yearly growth between 2010 and 2016 to reach almost 5 million connections
worldwide. The number of devices with integrated cellular connectivity is forecast
to grow at a yearly rate of almost 35% in the five-year period ending 2016 to reach
almost 2.5 million. mHealth refers to data services, applications and
communications related to mobile health. In addition, mHealthcare and home
monitoring are widely used to monitor chronic conditions such as diabetes, cardiac
arrhythmia, chronic obstructive pulmonary disease, ischemic diseases and
hypertension. According to Berg Insight, over 200 million individuals in the US
and the EU suffer from one or more diseases for which home monitoring is a
suitable option.
 Technological developments within the healthcare sector help to keep costs
down and elaborate more suitable methods to monitor and treat medical conditions.
The potential for wireless technologies remains vast, as it is relatively new to the
market. There were more than two million individuals using home monitoring
devices with integrated connectivity at the end of 2011.
 The global regenerative medicine market exceeded $7 billion in 2010,
according to RNCOS. This relatively new sector encompasses many disciplines
including stem-cell biology, bioengineering, Nano-science and tissue engineering.
Factors fuelling market growth include higher incidence of degenerative diseases,
aging population and technological innovation.
MarketOutlook

 The global healthcare system is increasingly overburdened, with rising
numbers of people suffering from chronic diseases and lifestyle-related conditions.
Expenditure continues to grow due to an expanding, and aging, global population.
BCC Research points to the role played by universal healthcare coverage in
boosting healthcare system efficiency. As budgets tighten and costs rise,
technological development is becoming increasingly important, with health
practitioners likely to continue making greater use of communications and
information technology to treat their patients.
INDIAN HOSPITAL INDUSTRY:
 The Indian healthcare industry has the potential to become a global hub for
healthcare services. The liberalization and the entry of global pharmaceutical
companies have contributed to the growth of the Indian healthcare industry.
Overview:
The Indian healthcare dates back to the Vedic system of healthcare (Ayurveda) in
5000 BC. Ayurveda proliferated the most during the Vedic period. The Ayurvedic
principles of positive health and therapeutic measures relate to physical, mental,
social and spiritual welfare of human beings. During the early Vedic period,
Ayurveda was perhaps the only system of overall healthcare and medicine. It
enjoyed the unquestioned patronage and support of the people and their rulers.
Thereafter, the long medieval history was marked by uncertain political conditions
and several invasions. This was when Ayurveda faced utter neglect and its growth
was stunted. The Unani medicine entered India during this time and gained
momentum with the extensive support of Mughal emperors. Later with the British
invasion, Allopathic made an entry into India. It was widely accepted because of
its swift results. Today, with continuous research and development, allopathic
dominates the Indian healthcare market. Healthcare industry in India is divided
into two segments: services and manufacturing. The manufacturing segment
consists of both medical equipment manufacturing industry and the pharmaceutical
production. In manufacturing segment they manufacture medical equipment, where
as in pharmaceutical production which manufactures Active pharmaceutical
ingredients and formulations.
The services segment is basically split into direct services and indirect services.
Further direct services are divided into:
1. Hospitals

2. Health insurance services
3. Research and Development
4. Clinical trials
Industry Structure & Segmentation:
Hospital industry structure is complex in nature, as the industry can be looked from
different angles. Each hospital is distinct in its characteristics as it differs in
structure, functions, performance and the community it serves. Hospitals are
normally classified into different types depending upon criteria like, objectives,
ownership and system of medicine. The sections below attempt to elaborate the
structure of hospitals in little more detail.
ClassificationofHospitals:
Hospitals are classified into different types depending upon different criteria.
Hospitals are divided into:
• Classification based on objectives
• Classification based on ownership
• Classification based on system of medicine
ClassificationBasedonObjectives:
Hospitals are classified into three categories based on objectives:
• General hospitals
• Specialty hospitals
• Teaching-cum-research hospitals
Generalhospitals
The main objective of these hospitals is to provide medical care where teaching
and research is secondary. General hospitals (GH) are well-known type of
hospitals, which deal with all kinds of diseases, injury and also has an emergency
ward to deal with immediate threats to health and capable to deliver emergency
medical services. GH has major healthcare facilities with large number of beds for
intensive care and long term treatment. The hospital is equipped to take care of
medical, surgical, maternity, and psychiatric cases, child birth, and plastic surgery
and usually has a resident medical staff.
Example: government run hospitals, primary healthcare centre, district and taluka
hospitals. Example: Osmania General Hospital, and Gandhi General Hospital.
Specialtyhospitals

A specialty hospital is dedicated to specific subspecialty care like pediatric centers,
oncology centers, psychiatric hospitals and others. Patients will often be referred
from smaller hospitals to a specialty hospital for major operations, and
consultations with subspecialists. These hospitals have highly trained specialists,
high-end technology and have the round the clock services. These hospitals are
able to do specialized tests, undertake dialysis for acute renal failure, provide
ventilation to patients with respiratory failure and render intensive care to critically
ill patients.
Teaching-cum-researchhospitals
The main objective of these hospitals is teaching based on research and the
provision of healthcare is secondary for example, All-India Institute of Medical
Sciences, New Delhi, and Post-Graduate Medical Education and Research
Institute, Chandigarh.
Classificationbasedonownership:
This classification is mainly based on the ownership of the hospital. It includes
hospitals like government, semi-government hospitals, voluntary agencies
hospitals and private or charitable hospitals. These hospital provide healthcare
services by charging nominal fee from the patient. Many of these hospitals run
their services with the help of government and the funds provided by the
industrialist.
Government hospitals
These hospitals are government-run hospitals; they are either managed by central
government or state government. One of the major purpose of these hospitals is to
provide free or charged healthcare services at a very nominal cost to poor people. J
J Hospital in Mumbai is an example of such a hospital. However, there are other
hospitals like railway hospital or defense hospital which are for providing
healthcare services to the employees of Railways and Defense of Government of
India.
Semi-government hospitals
These hospitals are owned by semi-government organizations like Employees State
Insurance (ESI) hospital. Some of the hospitals in this category is managed by
various municipalities/gram panchayats, etc.
Voluntary agencieshospitals

These hospitals are run with the funds received from various industrialists, national
and international charity organizations. Specialists from different countries visit
these Hospitals at regular intervals. Some examples include Sri Satya Sai Super
Speciality Hospitals in Puttaparthi, Andhra Pradesh and Bangaluru, as well as
Amrita Institute of Medical Sciences and Research Centre in Cochin, Kerala..
Charity hospitals
In India, charity hospitals have become a popular way of giving back to the
society. Many industrialists have sought to serve the society by promoting
hospitals. Such
Hospitals fall into two categories: not-for-profit hospitals and free hospitals.
Example: Christian Medical College and hospital in Tamil Nadu.
ClassificationBasedonSystem of Medicine:
In addition to allopathic, increasing number of patients are relying on Indian
systems of medicine such as Ayurveda, Homoeopathy and Unani. The Indian
systems of medicine are recognised by the union government. Most states are
actively involved in colleges that teach Ayurveda, Homoeopathy and Unani. In
addition, many traditional systems prevail in India particularly in rural and agency
areas. Typically, the local priest or village head administers medicines made of
locally-available herbs. While the Indian systems of medicine certainly have their
advantages, a majority of rural population relies on these systems due to lack of
allopathic facilities, low purchasing power and illiteracy. The Indian systems of
medicine largely rely on herbs from the foot hills of Himalayas, tropical regions of
Vindhya Mountains, Western Ghats and the north-eastern part of India. These
herbs form the basis for a range of medicines such as decoctions, powders and
liquids. In addition to herbs, other sources are also used to prepare medicines in the
Indian systems of medicine. The following are the total number of hospitals in
system of Medicine
1 Ayurveda
2 Unani
3 Homoeopathic
The history of the development of hospitals shows how there is increasing
competition between hospitals.
“When more than one hospital exists in a local area they compete for market share,
since greater market share has a positive effect on economies of scale, utilization
rates, learning curves and levels of quality. Competition is not only with other
hospitals, but also with doctors who now perform some procedures in their offices,

and with specialized clinics…strategy is to attract physician allegiance since they
act as gate- keepers, directing patients to specific hospitals”.
Hospitals have to compete for patients and to get on insurance companies' lists
since there are hospital competition has been found to be socially beneficial
because as the competition rises, hospitals provide higher quality care at lower
prices, which is advantageous to patients’ health. However, in order to keep
increasing the quality of care, hospitals need to find new ways to serve patients and
improve patient flows throughout the hospital. This will help to decrease costs and
increase patient and employee satisfaction, which are great ways to gain a
competitive advantage. In addition, hospitals like Backus are tracking the
government’s progress on the reorganization of the healthcare system and want to
streamline costs now before new and unexpected costs arise from the changes.
Little research has been done in hospital performance, but it is known that they are
extremely slow to change and implement improvements, and cannot keep up with
the demand for their services. For example,. “Hospital emergency departments in
the US are facing increasing challenges due to growth in patient demand for their
services, and inability to increase capacity to match demand”
Operational Research is relatively new to healthcare. Overcrowded emergency
departments and long waiting times are a widespread issue. It is difficult to
implement academic recommendations in the real world without continued
clinician support (a champion) patient flow in hospitals has been studied
extensively. Readers are referred to the many papers in Hall (2006), which are also
sources for further references. In the present section, we merely touch on three
dimensions, which are the most relevant for our study.

Introduction :
Out Patient Department Services are one of the important aspect of Hospital
Administration.OPD is the mirror of the hospital, which reflects the functioning of
the hospital being the first point of contact between the patient and the hospital
staff. OPD is visited by large section of community, the human relation skill/
Public relation functions are of utmost importance. OPD staff should be polite,
cheerful, cooperative & efficient.
Patients visit the OPD for various purposes, like consultation, day care treatment;
investigation, referral, admission and post discharge follow up not only for
treatment but also for preventing and promoting services, the first impression of
the hospital is formed from OPD and this is the area frequently visited by a
majority of patients.
The OPD is located on the ground floor, preferably with the separate entrance. The
diagnostic services should be easily approachable from here. Reception, waiting
area, Doctors chamber, examination room, minor O.T. and medical examination
room are easily accessible. systematic examination of methods of carrying on
activities so as to improve the effective use of manpower and equipment and to set
up standards of performance for the activities being performed and also the
systematic recording and critical examination of the ways of doing things to make
improvements one have to establish time standards for carrying out specified jobs
and estimates how long a job should take and the manpower and equipment
requirements for a given method.
It is believed that patient satisfaction can be enhanced and sub-sequent health
behavior improved, if providers create an environment that dialogue between the
health professional and the patient that enables them to identify the most important
and relevant information to transmit to patients and families. It can be
hypothesized that understanding and meeting patients need to know through
communicating important information desired by the patient can produce more
knowledgeable and competent patients who are in a better position to assist their
own recovery from illness and manage their own health. While these factors may
vary by diagnostic conditions and patient characteristics there is growing evidence
that the impact of information may be helpful.
The advantages of study in hospital OPD are to improve the methods / procedures
of various jobs .Out Patient Department should improve both Clinical and non-
clinical facilities such as overall OPD layout that can decrease the overcrowding
and de-lay in consultation, In hospitals this can also include reducing the efforts
patients need for treatment as well as for their routine hospital checkup.

ABOUT COLUMBIA ASIA HOSPITAL, KHARADI, PUNE.
Pune - Overview
Columbia Asia Hospital – Pune
It is a 100 bedded multi specialty facility situated close to the IT Parks at Kharadi.
The hospital has highly qualified medical personnel and technicians to ensure
healthcare delivery of the highest quality. It offers a wide range of clinical services
such as cardiology, obstetrics & gynecology, minimally invasive surgeries,
medical and surgical oncology, pediatrics and neonatology, ophthalmology,
urology, gastroenterology, renal transplants, orthopedics, joint replacements,
plastic surgery and bariatric surgery.
The hospital’s infrastructure along with internationally benchmarked standards of
medical, nursing and operating protocols is the key components that will make it a
preferred hospital in Pune. A proprietary hospital information system and
electronicmedical record management assures error free and convenient patient
records management, thereby greatly minimizing patient waiting time.
Year Established- 2013
Business Information
Columbia Asia Hospital in Kharadi, Pune
This is one of the best hospitals not just in India but Asia also. Columbia Asia
Hospitals Pvt. Ltd. is one of the foremost healthcare companies to enter Indian

shores through 100% foreign direct investment (FDI) route. This Group is owned
by150 plus private equity companies, fund management organizations and
individual investors. The very first hospital of this group was started in 2005 in
Hebbal - Bangalore. Currently this healthcare group has six multispecialty
hospitals, one referral hospital and a clinic. The group has presence in Bangalore,
Mysore, Kolkata, Gurgaon, Ghaziabad, Patiala and Pune. In Pune the hospital is
located at Kharadi. All the hospitals of the group are clean, affordable and follow
strict rules and policy so as to ensure that the patients are always in good care.
Clinical services atColumbia Asia Hospital, Kharadi
Following are the specialties at the hospital: Anesthesiology, Cardiology, Critical
Care Medicine, Dermatology, Emergency Medicine, ENT, Gastroenterology,
General Surgery, Internal Medicine, Neonatology, Nephrology and Renal
Transplant, Neurology, Neurosurgery, Obstetrics &Gynecology, Ophthalmology,
Oral & Maxillo-Facial Surgery, Orthopedics, Pediatric Surgery, Pediatrics, Plastic
& Reconstructive Surgery, Psychiatry, Rheumatology, Urology and Vascular
Surgery.
24-Hour services: Emergency room, Laboratory, Pharmacy, Radiology and
Ambulance. Specialty Clinics: 8 AM to 8 PM Outpatient clinics, Healthcheck
packages: Comprehensive healthcheck - below 30 years. Special Clinics: Travel
medicine, Shoulder clinic, Cochlear implant and bone anchored hearing aid clinic,
Sports medicine and arthroscopy, Cancer screening, Cardiac screening, Diabetes
clinic, Joint replacement clinic, Pain clinic and Weight loss clinic. Blood storage
centre: Blood components.
Facilities atColumbia Asia, Pune
Laboratory: Histopathology, Clinical pathology, Cytology, Biochemistry and
Microbiology. Diagnostic imaging: MRI, Interventional radiology, Picture archival
communication system, Teleradiology, Digitized radiography, Ultrasound & color
Doppler, Echocardiography, Digitized mammography and16 - Slice CT. Operating
theatre: Central sterile services department and Major & minor surgery.
Ambulatory &daycare: Daycare surgery, Endoscopy and Dialysis. Cafeteria:
Inpatient dining and Outpatient dining. Nursing units: Intensive care, Isolation
care, Labor and delivery suite, Neonatal intensive care and Nursery. Patient
accommodation: Rooms, Intensive care units and High dependency unit.
Other miscellaneous services offered includes Ambulance services, Drinking
Water, Housekeeping, Internet Access and Business Facilities, Information desk,
Laundry, Lost and Found department, Unclaimed Baggage / Articles, Dietician,
Newspaper, 24 hour pharmacy, Telephone, Television in rooms.

Services offered to International patients include assistance with Accommodation,
Travel & Foreign Currency, services of a Finance Manager or Insurance
Coordinator, Language interpreter service, Made to Order Cuisine etc.
Columbia Asia Group of Hospitals
Columbia Asia is an international healthcare provider with a chain of hospitals
across India, Malaysia, Vietnam and Indonesia. The company’s highly skilled
medical experts deliver care in modern hospitals specifically designed for the
needs of patients and built for maximum comfortand efficiency.
Columbia Asia integrates evidence-based, internationally benchmarked medical
practices with the latest technology, while providing the highest quality patient
care. Our hospitals specialize in Transplants (Kidney, Liver), Interventional
Cardiology and Cardiac Surgery, Neurosurgery, Orthopedic Surgery, Surgical
Oncology, Cosmetic and Bariatric Surgery and High-risk Pregnancies, among
others. Columbia Asia has hospitals in several cities in India and is in the process
of setting up facilities in additional locations too.

Leading the Way
Columbia Asia has a clear vision: Provide excellent, affordable care in modern
facilities centered on patients' needs. Columbia Asia's highly skilled doctors and
nurses deliver care in modern hospitals located close to where people live and
work. Columbia Asia hospitals are specifically designed for the needs of patients
and built for maximum comfort and efficiency. Patients benefit from advanced
medical diagnostics, treatment and the personal care that only comes in facilities
where the focus is on each patient.
Columbia Asia provides excellent care at affordable prices. Our transparent rate
structure for medical procedures allows patients to know in advance how much
their care will cost. There are no hidden or extra charges.
Columbia Asia Hospital is like a one man army in the health industry. With a chain
of hospitals serving countries like Malaysia, India, Indonesia and Vietnam, the
group has made a name and place for itself. The company as a brand came up in
the year 1994. It has its headquarters in Kuala Lumpur in Malaysia. The hospitals
across the four nations are built with an aim to heal more and more number of
people with efficient means and advanced medical techniques. Comparatively
smaller in size, the hospitals are just the organization meant for public service.
Spending lesser on the size and more on the medical equipments, Columbia Asia
focuses more on building a proper healthcare set up. Service oriented hospitals are
run under the company; Columbia Asia. The hospital sees a maximum of 8,000
patients every month. The overall monthly revenues earned by the hospital are over
one million dollars.
Skilled doctors and well trained medical professionals are hired every year to
improve the medical services provided by the hospitals in four nations. With over

2600 employees and further plans for expansion, Columbia Asia is growing in size
and popularity. The doctors and staffs are recruited from the local area. The
company owns about 14 hospitals, which are under construction. 12 other
properties are owned by the company. On completion of these projects, the
company will have 11 hospitals in the Malaysian nation, 3 in Vietnam, 21 hospitals
in India and about 3 in Indonesia.
SWOT ANALYSIS
SWOT analysis is a strategic planning method used to evaluate the Strengths,
Weaknesses, Opportunities, and Threats involved in a project or in a business
venture. It involves specifying the objective of the business venture or project and
identifying the internal andexternal factors that are favorable and unfavorable to
achieve that objective. The technique is credited to Albert Humphrey, who led a
convention at Stanford University in the 1960s and 1970s using data from Fortune
500 companies.
A SWOT analysis must first start with defining a desired end state or objective. A
SWOT analysis may be incorporated into the strategic planning model. Strategic
Planning has been the subject of much research.
Strengths: characteristics of the business or team that give it an advantage over
others in theindustry.
Weaknesses: are characteristics that place the firm at a disadvantage relative to
others.

Opportunities: external chances to make greater sales or profits in the
environment.
Threats: external elements in the environment that could cause trouble for the
business.
Identification of SWOTs is essential because subsequent steps in the process of
planning forachievement of the selected objective may be derived from the
SWOTs. First, the decisionmakers have to determine whether the objective is
attainable, given the SWOTs. If the objective is NOT attainable a different
objective must be selected and the process repeated. The SWOT analysis is often
used in academia to highlight and identify strengths, weaknesses, opportunities and
threats. It is particularly helpful in identifying areas for development. SWOT
analysis is a tool for auditing an organization and its environment. It is the first
stage of planning and helps marketers to focus on key issues. SWOT stands for
strengths, weaknesses, opportunities, and threats. Strengths and weaknesses are
internal factors. Opportunities and threats are external factors.
MARKETING AS A VALUE DELIVERING PROCESS
The success of the firm depends upon its ability to deliver better value to the
customer than its competitor. Marketing can be seen as the value delivering
process. Thevalue creation and delivery sequence can be divided into three phases.
The first phase, choosing the value includes segmentation, targeting and
positioning i.e. dividing the heterogeneous market into homogeneous segments,
identifying target markets and developing offerings value positioning i.e. position
the productas delivering central benefits most sought after by target market.
The second phase is providing the value. This involves identifying product
features, pricing and distribution.
The third phase is communicating the value by utilizing the sales force, sales
promotion, advertising, and other communication tools to promote the product.
Each of these phases adds cost and provides benefits. Value delivery process
begins before there is a product and continues while it is being developed and after
it becomes available.
MARKETING ENVIRONMENT
The success of any company is based on well it respond to the changes occurring
in the environment it operates.
The Marketing Environment can be defined as all the internal and external
forces that influence marketing activities of the firm.

The internal environment forces include a firm’s production, financial, personnel,
R&D, and company image and other related facilities which are more or less
controllable by management.
The external forces can be further divided into microenvironment and macro
environment.
The microenvironment consists of the suppliers, customers and marketing
intermediaries while the macro environment includes demography, socio-cultural,
technological, political, economical and legal environment.
EXTERNALMICROENVIRONMENTFACTORS:--
The external microenvironment includes:
1. MarketDemand
2. The Consumers
3. Suppliers
EXTERNALMACRO ENVIRONMENT FACTORS:--
Demographic Environment:-
i) Population
ii) Age wise classification
Other demographic variables:--
iii) Occupationand literacy
iv) Location
Political& Legal environment:-
Marketing activities and marketing decisions are greatly influenced by
development in the political and legal environment. This environment includes
form of the Government adopted, stability of the government, government policies,
laws, rules & regulations, social and religious organizations, government agencies,
political ideologies, media and pressure groups that restrict and influence political
organizations. Businesses have to operate within the framework of the prevailing
legal environment. They have to understand the implications of all the legal
provisions relating to their business. Central and State government regulate
business legislation covering areas like corporateaffairs, taxation, consumer
protection, protection to selected business sectors, protection ofsociety as a whole
against unfair business practices, regulations on products, prices &distribution,
control on trade practices, protecting domestic firms against the onslaught of
foreign firms etc. MNC’s operating in different countries need to understand legal
environment prevailing in various countries.

Economic Environment: -
Economic environment consists of economic policies, economic systems, and
economic conditions prevailing in the country. Economic policies consists of
export-import policies, industrial policies etc. Economic system includes free
market economy, mixed economy etc. Economic conditions include interest rates,
inflation rate etc. Marketer need to pay attention to different economic variables as
gross domestic product, disposable income and purchase power of different
population segments, rate of growth of economy and different sectors, credit
availability and interest rate, behavior of capital market, exchange rates, capital
rates etc. Marketer need to know the different stages of business cycle and the
stage of cycle economy is currently operating into. The business cycle consists of
four stages: -Recovery, Boom Recessionand Depression.
Socio-culturalEnvironment: --
Socio-cultural environmental factors include culture, traditions, attitudes, norms,
values and lifestyles of people. Social factors affect how people live and behave
thus deciding customer buying behavior which eventually influences firm’s
marketing plans and programs.
Culture: -
Culture is the combined result of factors like religion, language, education and
upbringing. Some cultural values are deep rooted and do not change easily called
core-cultural values e.g. faith in marriage. There are also values and practices
which may change over the period of time called secondary values. The cultural
shifts carry with them marketing opportunities as well as threats. e.g. Influences of
western countries have considerably affected food and clothing habits of Indian
customers.
Socialclass:-
Any society is composed of different social classes. A social class is determined by
income, occupation, location of residents etc. Each class has its own standards with
respect to lifestyle, behavior etc. known as class values or class norms. E.g. people
belonging to middle class are more prices conscious. Certain changes can be
observed in Indian social environment like increasing number of nuclear families,
growing awareness about consumer rights, growth in number of working women,
concern for environment, and change in attitude towards health and recreation.

Increase in number of working women has caused growth in demand for domestic
appliances, ready-to-cook food items, beauty products etc. Increased interest of
people in better health and fitness has brought more business for sports goods,
fitness centers, and private sports clubs. It has also brought changes in the eating
and dieting habits of people. Demand for health foods, health drinks, low calorie
diets have gone up. Growing influence of social cultural forces has compelled
marketer to embrace societal marketing concept.
TechnologicalEnvironment: -
Technology has a very wide impact on all marketing activities. It also has
tremendous impact on our life style, consumption pattern and our economic well
being. New machines can reduce production costs; the increasing computing and
processing capabilities of computers is increasing effectiveness and efficiency of
the business. Companies can make better product at lower costs and plan truly
global supply chains where manufacturing and warehousing are disbursed
throughout the world depending upon cost-effectiveness. The technology has
helped marketer in environment analysis and decision making (MIS, Decision
supportsystem).
Competitive Environment:
The Competitive Environment has a major influence on marketing programs of
companies. Companies need to constantly assess the competition, anticipate
competitive actions and formulate marketing strategies to deal with them.
Competitors considerably influence the company’s choice of marketing strategies
particularly in relation to selection of target market, suppliers, marketing channels
as well as product mix, promotion mix and price mix. Company may face
competition at different levels. A company competes with companies offering
similar products and services. e.g. Surf and Ariel, Colgate and Pepsodentetc.
Natural Environment: -
The ecological balance has been disturbed by the rapid industrialization, higher
consumption of fossil fuels, increasing consumerism and rapid urbanization. This
has resulted in Ozone layer depletion, global warming and various other problems.

SEGMENTATION,TARGETINGAND POSITIONING
BASES FOR SEGMENTATION OF CONSUMER MARKET
1) Geographic Segmentation
2) Demographic Segmentation
a. Age and Life Cycle stage
b. Gender
c. Income
d. Generation
e. Social Class
3) Psychographic Segmentation
a. Life Style:-
b. Personality: -
c. Values:-
4) BehavioralSegmentation
a. Occasions
b. Benefits
c. Usage Rate
d. Loyalty Status
e. Buyer Readiness Stage
f. Attitude

SERVICE
In economics, a service is an intangible commodity. More specifically, services are
an intangible equivalent of economic goods.
Service provision is often an economic activity where the buyer does not generally,
except by exclusive contract, obtain exclusive ownership of the thing purchased.
The benefits of such a service, if priced, are held to be self-evident in the buyer's
willingness to pay for it. Public services are those society (nation state, fiscal
union, regional) as a whole pays for through taxes and other means.
By composing and orchestrating the appropriate level of resources, skill, ingenuity,
and experience for effecting specific benefits for service consumers, service
providers participate in an economy without the restrictions of carrying inventory
(stock) or the need to concern themselves with bulky raw materials. On the other
hand, their investment in expertise does require consistent service marketing and
upgrading in the face of competition == Service characteristics == Services can be
paraphrased in terms of their generic key characteristics.
1. Intangibility
Services are intangible and insubstantial: they cannot be touched, gripped,
handled, looked at, smelled or tasted. Thus, there is neither potential nor need for
transport, storage or stocking of services. Furthermore, a service can be (re)sold or
owned by somebody, but it cannot be turned over from the service provider to the
service consumer. Solely, the service delivery can be commissioned to a service
provider who must generate and render the service at the distinct request of an
authorized service consumer.
2. Perishability
Services are perishable in two regards

 The service relevant resources, processes and systems are assigned for
service delivery during a definite period in time. If the designated or scheduled
service consumer does not request, an empty seat on a plane never can be utilized
and charged after departure.
 When the service has been completely rendered to the requesting service
consumer, this particular service irreversibly vanishes as it has been consumed by
the service consumer. Example: the passenger has been transported to the
destination and cannot be transported again to this location at this point in time.

3. Inseparability
The service provider is indispensable for service delivery as he must promptly
generate and render the service to the requesting service consumer. In many cases
the service delivery is executed automatically but the service provider must
preparatory assign resources and systems and actively keeps up appropriate service
delivery readiness and capabilities. Additionally, the service consumer is
inseparable from service delivery because he is involved in it from requesting it up
to consuming the rendered benefits. Examples: The service consumer must sit in
the hair dresser's shop & chair or in the plane & seat; correspondingly, the hair
dresser or the pilot must be in the same shop or plane, respectively, for delivering
the service.
4. Simultaneity
Services are rendered and consumed during the same period of time. As soon as
the service consumer has requested the service (delivery), the particular service
must be generated from scratch without any delay and friction and the service
consumer instantaneously consumes the rendered benefits for executing his
upcoming activity or task.
5. Variability
Each service is unique. It is one-time generated, rendered and consumed and can
never be exactly repeated as the point in time, location, circumstances, conditions,
current configurations and/or assigned resources are different for the next delivery,
even if the same service consumer requests the same service. Many services are
regarded as heterogeneous or lacking homogeneity and are typically modified for
each service consumer or each new situation (consumerised). Example: The taxi
service which transports the service consumer from his home to the opera is
different from the taxi service which transports the same service consumer from
the opera to his home – another point in time, the other direction, maybe another
route, probably another taxi driver and cab.

Each of these characteristics is retractable per se and their inevitable coincidence
complicates the consistent. Each of these characteristics is retractable per se and
their inevitable coincidence complicates the consistent service conception and
makes service delivery a challenge in each and every case. Proper service
marketing requires creative visualization to effectively evoke a concrete image in
the service consumer's mind. From the service consumer's point of view, these
characteristics make it difficult, or even impossible, to evaluate or compare
services prior to experiencing the service delivery.
Service delivery
The delivery of a service typically involves six factors:
 The accountable service provider and his service suppliers (e.g. the people)
 Equipment used to provide the service (e.g. vehicles, cash registers,
technical systems, computer systems)
 The physical facilities (e.g. buildings, parking, waiting rooms)
 The requesting service consumer
 Other customers at the service delivery location
 Customer contact
The service encounter is defined as all activities involved in the service delivery
process. Some service managers use the term "moment of truth" to indicate that
defining point in a specific service encounter where interactions are most intense.
Many business theorists view service provision as a performance or act (sometimes
humorously referred to as dramaturgy, perhaps in reference to dramaturgy). The
location of the service delivery is referred to as the stage and the objects that
facilitate the service process are called props. A script is a sequence of behaviors
followed by all those involved, including the client(s). Some service dramas are
tightly scripted, others are more ad lib. Role congruence occurs when each actor
follows a script that harmonizes with the roles played by the other actors.
In some service industries, especially health care, dispute resolution, and social
services, a popular concept is the idea of the caseload, which refers to the total
number of patients, clients, litigants, or claimants that a given employee is
presently resp responsible for. On a daily basis, in all those fields, employees must
balance the needs of any individual case against the needs of all other current cases
as well as their own personal needs.
PATIENT SATISFACTION
Why Should You Evaluate Patient Satisfaction?

Improving the quality of patient care in hospitals is a vital and necessaryactivity.
Patients report they receive less individual attention than ever before. They
complain that doctors and nurses are too busy tending to the technical aspects of
care to provide the much needed attention to patient’s personal needs. While the
business community has been involved in assessing customer satisfaction for at
least a decade, the medical community has lagged considerably in assessing patient
satisfaction. More recent developments in the medical environment have prompted
the health care profession to recognize patients as valuable customers. Medical
groups have been more involved in this process due primarily to major incentives
from a payer driven to a patient-driven mode and the increase competition among
physicians arising from the diminished differences in price.
The National Committee for Quality Assurance(NCQA) efforts in the collection of
Health Plan Employer Data and Information Set survey results has also affected
the collection of patient satisfaction data in physicianpractices.There are many
reasons why critical access hospitals should evaluate patientsatisfaction. We are
often the poorest objective judge of one’s own appearance. It is also unusual for
those around us to give unsolicited criticism about the need forimprovement
(Emily Post advises against it as impolite). Most people when receivingpoor
service or bad food at a restaurant doesn’t complain, they just warn their friend’s
and refuse to return. You can be blissfully unaware of any problem and patients
remainunsatisfied.
Patient satisfaction is as important as other clinical health measures and is a
primary means of measuring the effectiveness of health care delivery. The current
competitiveenvironment has forced health care organizations to focus on patient
satisfaction as away to gain and maintain market share. If you don’t know what
your strengths and weaknesses are, you can’t compete effectively. The data
gathered through measuring patient satisfaction reflects care delivered by staffand
physicians and can serve as a tool in decision-making. Patient satisfaction surveys
can be tools for learning; they can give proportion to problem areas and a
referencepoint for making management decisions.
They can also serve as a means of holdingphysicians accountable – physicians can
be compelled to show they have acceptable levels of patient satisfaction. Patient
satisfaction data can also be used to document health care quality to accrediting
organizations and consumer groups and can provide leverage in negotiating
contracts. Probably the most important reason to conduct patient satisfaction
surveys is that theyprovide the ability to identify and resolve potential problems
before they becomeserious. They can also be used to assess and measure specific
initiatives or changesin service delivery. They can identify those operations and
procedures that require better explanation to patients. And most importantly, they

can increase patient loyalty by demonstrating you care about their perceptions and
are looking for ways to improve.
There are a number of challenges small facilities, in particular, may face with
conducting patient satisfaction surveys. These include: tight budgets, lack of
funding, lack ofcommitment from administration or staff, lack of in-house
expertise to plan and managetask, lack of in-house resources for existing staff, with
small sample size, designing a statistically valid sampling process, obtaining
acceptable response rates and reliabledata, properly analyzing and reporting survey
data, translating findings into informationthat can be used for program planning
and quality improvement efforts, no institutionalincentives for performance
improvement, and selecting a survey instrument that will produce valid and
reliable results. Although there are numerous challenges for small rural hospitals,
we are hoping this publication will make the process easier to understand and
manage.
What is Satisfaction?
Before attempting to evaluate patient satisfaction, we need to know what it is. How
we define patient satisfaction will help us structure an evaluation processes that
provide adequate measurements of the variables that contribute to a patients’ level
of satisfaction. Although most patients are generally satisfied with their service
experience, they may not be uniformly satisfied with all aspects of the care they
receive. Therein lays the challenge to management – how much service is enough
to elicit high satisfaction and keep them coming back?
A patient’s experience within a hospital environment is based on numerous
encounters with a wide variety of individuals and locations. The first encounter is
with the facility’s parking lot, followed by physically accessing the facility, the
admissions process, encounters with physicians, nurses, lab personnel, and other
service providers and their respective physical locations, including patient rooms
and the care they receive while in their room, the discharge process, and finally the
billing/payment process. There arena number of factors that could impact on the
patient’s perception of the care provided throughout an inpatient stay. Factors may
include the cleanliness of the environment, the appearance of the facility, the ease
of access to specific locations, the concern expressed from various staff and
providers for the patient’s well-being, the amount of time they had to wait before
getting care, the quality of the interaction with providers, the clarity of the
communication fromproviders, the outcome from the care provided, the cost of the
visit, the providers, the outcome from the care provided, the cost of the visit, the
quality of the food, the perceived efficiency in which care was delivered, and on
and on.

Over the years there have been various definitions of patient satisfaction. Susie
Linder-Pelz (1982b, p. 578), in her review of the patient satisfaction literature,
offers the following definition: patient satisfaction is “…positive evaluations of
distinct dimensions of the health care. (The care being evaluated might be a single
clinic visit, treatment throughout an illness episode, a particular health care setting
or plan, or the health care system in general.)”The suggestion by Linder-Pelz is
that satisfaction must be understood within the context in which a variety of
elements may be more or less satisfying to the patient. She identified 10 elements
that can be used to determine satisfaction:
1. Accessibility/convenience
2. Availability of resources
3. Continuity of care
4. Efficacy/outcomes of care
5. Finances
6. Humaneness
7. Information gathering
8. Information giving
9. Pleasantness of surroundings
10.Quality/competence
A well-designed patient satisfaction survey will incorporate these elements as it
relates to the total patient experience.
Survey Methods
There are two broad categories of surveys: the questionnaire and the interview.
Questionnaires are typically paper-and-pencil instruments that the patient
completes but also can include computerized versions that are accessed at thesite
through a kiosk or through the Internet. Interviews are completed by theinterviewer
and are based on what the patient says. The following section discusses the various
types of surveys and the advantages or capabilities and the disadvantages or
limitations of each type.
Interviews
Interviews are a more personal form of surveys than questionnaires. Interviews can
occur on an individual basis or within groups and either over the telephone or in
person. Properly conducted interviews can provide managers and decision makers

with a deeper understanding of patient perceptions about their
hospitalenvironment.Unlike structured survey methods which require strict
adherence to a set procedure to ensure the scientific accuracy of the results,
interviewing techniques are less rigid and concentrate more on revealing issues and
underlying face-to-face nature of group meetings enable you to not only ask
patients “what “are their issues, opinions, and needs, but also to probe “why” they
feel such issues, opinions and needs exist.
The interpersonal nature of interviews allows for much give and take of
information. Often during the course of an interview, issues raised will need
clarification from either the facility or patients. Interviews provide an outstanding
opportunity to answer questions and clarify issues .Conducting these interviews
can serve a public relations role for your organization. By providing patients with a
formal opportunity to express their views, your facility is making a strong
statement of its interest in the attitudes of patients. Still, the manners in which you
respond to the issues raised will ultimately demonstrate your respect for, and
commitment to patient involvement in the health care system. For the sake of
brevity, detailed information on the process of conductingindividual and/or group
interviews is not repeated here. Please refer to the publication “Conducting Key
Informant and Focus Group Interviews” for more specific information on the
process of interviewing. These same techniques can be applied to individual
patients and groups.
The advantage of interviews is their personal form. Unlike questionnaires, the
interviewer has the opportunity to probe or ask follow-up questions. Interviews are
generally easier for the respondent, especially if what is sought is opinions or
impressions. However, they can be very time-consuming and they are resource
intensive. The interviewer is considered a part of the measurement instrument and
interviewers have to be well trained in how to respond to any contingency. In
addition, if the interviewer is on the staff of the facility, there may be some
reticence by patients to share their perceptions openly and honestly. Even an
outside interviewer might encounter problems because the patient’s identity is
known. Interviews conducted bypeople external to the organization are preferable.
Questionnaires
When most people think of questionnaires, they think of written surveys. Written
surveys consist of the same exact instrument sent (usually mailed) to a wide
number of people. In this instance, a patient satisfaction survey could be
distributed directly to patients either at the completion of their inpatient stay or by
mailing them to their homes.

There are also digital ways to gather patient satisfaction data. Some facilities may
provide access to a kiosk that will allow patients to answer questions regarding
their stay. Others have websites that allow patients to provide feedback via the
Internet. The most obvious advantage to this approach is that data-entry is
completed by the patient, eliminating the need for manual data entry.
This also minimizes human error. However, this approach will not be appropriate
for all patients, especially those who are not computer literate or who do not have
access to the Internet. This might be a good option in combination with another
method of obtaining patient satisfaction data.
A second type of questionnaire is the group-administered questionnaire.
Thedifference between a group administered questionnaire and a group interview
is that each respondent is handed an identical survey to complete while in the
roomfor a group administered questionnaire and for a group interview,
respondentsdon’t complete a survey individually but listen and answer questions as
part of agroup.
There are many advantages to a written survey. They are relatively inexpensive to
administer and you can send the exact same survey to a wide number of people.
They allow the respondent to fill it out at their own convenience. They can be
completely anonymous and confidential, removing the fear of responding honestly.
However, the disadvantages are that response rates from written surveys are often
very low and they are not the best vehicles for asking for detailed written
responses. In addition, poorly designed questions can be misinterpreted by
respondents and incorrectly designed surveys may produce invalid and misleading
results.
Group administered questionnaires are also inexpensive to administer and could
increase the response rate. However, there may be reluctance on the part of the
patients to respond honestly for fear of being identified. Measures would be
necessary to insure confidentiality. The remaining sections of this publication,
discuss the specific steps to design, distribute, and analyze a patient satisfaction
survey using a written survey model.
ResearchMethodology
The Research approach adopted in this study is Questionnaire and Descriptive
Method.
This includes collection of data using observational checklist from patients
visiting Out Patient department.
CollectionOf Data

Primary Data: Observation Method, Interview Method with patients and staff
orally
SecondaryData: Internet, Articles, Other Sources
Sample Size: Sample size of 50 Patients is included in study.
Statistical Analysis: Graphical analysis interpretation.
To get actual quantified data and understand perception of patients: Questionnaire
was designed.
Questionnaire:
Used to collect data.
Data was collected from the Out- Patient Department during day (9.30 am – 4.30
pm). Data was mainly collected from the Patients who visited the Hospital OPD.
Waiting Time:
1) Demographics
Name of Patient:
Age: Gender: M/F
Registration No:
Occupation:
To eliminate any bias – randomized sampling was done and hence –
Gender: Male - 25 & Female - 25
Equal numbers of Male and Female patients were interviewed and options of both
were taken into consideration.
2) How did you come to know about our Hospital?
0
5
10
15
20
25
30
Male Female
Axis Title

a) Doctors Referral
b) Recommended buy other patients ,or relatives or friends
c) Website
d) News paper advertisement or TV Advertisements
e) Other (Please Specify)
From this we understand that maximum patients come by referral either from
patients who are already having treatment or have received treatment in past. Or
from those who know about the hospital.
Second important reason is news paper advertisements. So more attention should
be given to print media. Writing columns in reputed news paper also will help to
increase awareness about the hospital.
3. How was first appointment taken?
a) Personally visited for inquiry
b) Relatives came to inquiry
c) Telephonic inquiry
d) Directly came without appointment
6%
74%
6%
10%
4%
First Information
Doctors Referral Patients ,or relatives or friends
Website News paper advertisement
Other

This helped me to understand that maximum patients, more than 60% - first
interact on telephone, and do enquiry before coming. So, more attention on
improving that should be given. Patients all queries should be answered & all
information should be given with full clarity.
4. First visit details
From your place of residence –How did u come to hospital?
This question was included- as patient flow not only starts from the entrance gate
of hospital, but it starts – right from patient’s house.
7%
25%
63%
5%
First appointment taken by -
Personally visited for inquiry Realtives came to inquiry
Telephonic inquiry Directly came without appointment

This data reveals that maximum patients come by four wheeler. Many patients
come from very far location so they have to either they have to come by own car or
hire a bus or auto .Also many patients – don’t have physical capacity to travel by
auto or on 2 wheeler. So, in spite of extra burden of cost,many patients have to
bare costfor four wheeler.
From feedback- it was clear, that things have to be done. They are –
 Make more covered parking space available to all 4 wheeler. As people find
it difficult as there is very little spacefor four wheeler.
Quantitative Data –Regarding Time.
I used interval scale for assessing time factor.
5. Time taken for registration Process?
a) Less than 5 minutes
b) 5-10 minutes
c) 10-20 minutes and the last one is –
d) More than 20 minute
Bus Own Car Two wheeler Auto
9
24
12
5
Mode Of Transport

6
23
17
4
Less than 5 Minutes
5-10 Minutes
10-20 Minutes
> 20 Minutes
Registration Time

6. Waiting time to see doctors?
Time to see consultant:
a) Less than 15 minutes
b) 15 minutes to 1 hour
c) 1 hour to 3 hours
d) > 3 hours
Waiting Time to see consultant Feedback
Less than 15 minutes 4
15 minutes to 1 hour 25
1 hour to 3 hours 20
>3 hours 1
This reveals that maximun patients have to wait for atleast 1 to 2 hours to see
consultant. Also many patients said that time varies a lot.
This is the main portion of total waiting time. So ,once this is managed ,then we
can achieve to reduce total waiting time ,and also increase patient satisfaction .
7. In this I was interested to know the waiting area comfortable for patients and
their relatives ? Whichfacilities are currently available ? And is there anything that
needs to be improved or added ?
1) Do you find the waiting area comfortable ?
Yes/ NO ( please give your comments if any )
4
25
20
1
Less than 15 minutes
15 minutes to 1 hour
1 hour to 3 hours
>3 hours
Waiting time for consultant

 Almost all patients agreed that waiting area is comfortable – But observed
that many patients relatives occupy the waiting area as there is no separate wating
area for relatives whos family member is admitted. So this hsould be informed .
And there are no beds in waiting area,Separate room should be provided for that.
2) What facilities are available ?
- Comfortable chairs or beds ?
- Water , tea or coffee machine ?
- Fans, lights & ventilation ?
All patients said that – Lighting ,Ventilation was satisfactory.
Pure filtered water is kept near waiting area .
Patients are satisfied with canteen facilities.
8) What you normally do while waiting ?
This was again an open ended question and many people said – that they just wait
and do nothing , other than thinking about – how much more time ?
So , to avoid this,and increase patient satisfaction , we may select options- from
next question and make utilization of current available waiting time .
9) What would you prefer to do during the waiting time ?
a) Read books or magazines
b) Watch informative CD, or Presentations
c) Watch cartoons or light programs
d) Relax or sleep
e) Other than this (Please Specify)
29
32
10 10
3
Preference

This question was asked , and multiple answering was allowed.As many patients
opted for more than one options – so we understand that – what is more preferred
over what.
Data reveals that –
32 people have opted to watch informative CD, or presentations. They said that –it
will be surely helpful to know them do’s and don’ts.Also – that will keep them
engaged which will reduce anxiety ,and also be helpful for their relatives to take
good care at home , and avoid common mistakes .
Also 29 out of 50 were interested to read books or magazines. Maximum being
from urban area , are literate . And so – they said that – informative books and
magazines will be useful. Also some other books for light reading may be useful to
divert mind from pain and stress.These things can be implemented, to make patient
relax , and help to reduce anxiety
10. Were you informed about your waiting number or current status or doctor’s
arrival timw , or expected waiting time ?
a) Always
b) Most of the times
c) Only when asked
d) Never
Information given Feedback
Always 2
Most of the times 8
Only when asked 24
Never 16
Always Most of the
times
Only when
asked
Never
2
8
24
16
Informationgiven

This data tells that – almost half the patients have to ask by themselves – about
waiting number or current status or doctor’s arrival time, or expected waiting time.
That sometimes makes them unstable, anxious and hence may affect patient
satisfaction level.
So, hospital should adopt – Token System
Common problems to be encounteredin OPD systemare as follows:
 Long patients wait time will occurat the front desk of the hospital.
 Patients might be conveyed to wrong services.
 Large number of patients waiting to be served at the OPD will result in
uncomfortable conditions such as congestion, noise, and poorventilation.
 Long work-shifts will cause cleaning crew to wait idle and related cost will
increase
Patients could prefer another health clinic due to improper management.
Solution :
The delay can be avoided if the patients at the time of registration may be advised
about the probable time of his turn. This can help the patient in chalking out his
schedule. Besides, the patients from the village may be given preference so that
they can go back to their village after examination and consultation and thus may
not unnecessarily crowd the hospital premises.
Recommendations:
 By word of mouth publicity from relatives and close friends only one doctor
is more recognised and famous as compared to other doctors
 More availability of the doctorin the hospital
 Easy going and adjusts with the cost of surgery which is affordable by all
class of people .
 Word of Mouth plays an important role in increasing the revenue at the
hospital OPD
 The Marketing Department should do market study for more recognised
doctors forthe each department on panel who can generate more revenue.
 According to my observation the hospital is at risk by keeping a hope on just
one doctor(ofrespective department) hoping that hospital will get enough revenue
 Even Doctors now a days are more aware of the market availability and
there demand in market with such good experience as it is observed already the
patients are being diverted from the hospital to there private OPD as well as for
surgery either to the other hospital to the doctor is attached or there own small
hospital setup . So the administrative staff should take into notice about it and take
a quick action to appoint more experienced doctorwho are available in the market

 On Market study and it’s been notices that many other hospitals in Pune and
Mumbai where the doctors has been given the per day target of patients as well as
surgeries
If they don’t get the revenue that is expected by the hospital the doctor is asked to
leave from the panel the same thing has to be followed by the hospital if the
revenue generation is the current concern.
 The Marketing Department should take initiative and do more marketing for
the doctor’s who have less patients as compared to other
Being in Pune its been observed that public in market is more turning to safer
drugs available in the market that is Ayurvedic and Homoeopathy mode of
treatment which are safer drugs .If compared to other hospitals like DMH they
have many doctors who work with them for Ayurvedic and homoeopathic panel.
 Here same the marketing and R&D Dept should hire some Specialized
doctors who are ready to join for opd from 8pm to 10 pm, as if many IT companies
office get over at around 7pm or 8 pm even the office people can easily get a
appointment and visit a doctor.
 Many times it’s been observed that some investigation are not available at
the hospital so the patient is recommended to get the test done from other hospital.
So the administrative staff should take it into notice as many patients are getting
diverted in this way to
 Increase the no of bed in the hospital as many patients are getting diverted to
other hospital because of non availability of the bed at the right time.
 Signages:They play an important role in the hospital which is like a maze.
 They have to keep on asking at least 2-3 persons who come on their way for
the direction .
 Signages should be user-friendly ,so that even a non educated person should
easly read it.
 Best solution is to put up a board just next to OPD reception with proper
signages
 If revenue generation is the issue the main initiative the hospital should do is
the more marketing about the doctor who don’t have many patients or either make
them set a target for revenue generation.
 There is no use in just wasting the time slot that has been given to the
doctors who just don’t get more than 2-3 patients .instead hire new doctors who
can get more patients and profit the hospital.
 Observed that doctors who have just 1-2 patients they don’t just come to the
opd time schedule ,before coming they ring up at OPD reception counter and

confirm about their patients if they find there is just one patient they just don’t turn
up at the OPD .
 Toilets are not clean
 The passagearea should be kept clean and dry as far as possible.
 The housekeeping Department should be more alert and quick to guide the
visiting patients to flush the toilet
 Include more seating arrangements to the patients as there is more rush from
9.30 am to 11.30 am
 It is inconvenient for the patients to wait for long time in standing position
due to less seating arrangements and even the doctor’s delay in starting opd results
in more fatigue.
Since the outpatients are considered as the best marketing agent for the
hospital.
Apart from the quality of staff, equipments the main feelings and image carried by
patients about hospital mainly depends on human aspect and the concern,
sympathy and understanding shown by hospital staff.
 TokenSystemto reduce waiting time :
 This is as a protocol, when patients arrives first at reception desk, they
should first be informed about –has consultant- that is has the doctorarrived or not.
 Then patient should be given token, so that –they will get idea- where they
stand, and how much time approximately will be there.
 This gives a secured feel to patients, and will also help us manage patients
flow , without affecting their satisfaction.
 Then patient should be sent to get follow up done by senior or junior
research fellows.
 Then once follow up is done, patient should be transferred to waiting area,
where- comfortable chairs, and minimum 2 beds should be kept. As – few patients
are not able to sit for long time, so for them beds should be there, with a curtain –
as separation.
 Token System: As patient will be having a token number in his/her hand ,
and current number will be displayed on the machine – so patient will be assured
about what is actually happening.
 Also – this assurance will make the patient relax, and sit in one room, which
will be easy to manage. Also – patient can rest, read books , watch CD, or
presentations – in that room .

 Then for example –X patient has token no 21, and currently number is 16 on
board, that patient will know that there is still time, if needed he may go to

washroom, and then wait again .No need to hold natural urge.
 Or even- when patient has number 18, and currently 16 number is gone, then
he/she can start getting ready to go inside , and when 17 number goes inside-we
can ask -18th patient to come and sit on the chair next to Doctors cabin.
 This will avoid time wastage – in patient shifting ,and also wil avoid
overcrowding of all patients in front of cabin
 Also – patient wont trouble doctors and receptionist – by continuously
asking about – how many still to go ?
 This will create an image – of transparency in patients mind. And hence
patient satisfaction level will Increase.
 And for VIP patients, or extra critical patients, who need to be addressed
urgently,- they should not be given token number. As – if they are given token
number- and if other patients see them bypassing, then they will feel bad. As-
every patient who is coming, is suffering from some other ailments- which itself
makes every patient anxious.
 Then, if these –emergency patients come, they should be directed to cabin
separately. And here – on machine, the last number should not be changed.
Patients waiting – won’t know that someone else has gone. They will think that last
patient- for example 26 has gone in, and still that patients hasn’t come out .And
number 27 is ready to wait till his/her number is not displayed.
 This system should be implemented, which will surely make whole system
function smoothly.
Conclusion:
This Study – gave a clear idea of current scenario , and what all bottlenecks are.
Which are the things – which are appreciated by patients, and what are area for
improvement. I believe that few suggestions can certainly show improvement in
operational management and also perception of patients. And this study
emphasises on imprortanceof TIME factor in patient’s satisfaction level .Patient
flow can be streamlined, to give best results.
BILLING: WHAT, WHEN AND HOW
Brief History of MedicalBilling and Collections
Many decades ago, the business aspects of hospitals worked much like the business
aspects of any other service industry. Physicians charged a fee for their services,
and the patients received and usually paid the bills. Prices were reasonable, and the
physician had flexibility to do charity work when he or she felt it necessary or
appropriate. Most doctors made a healthy living, and had no problem providing a

reasonable amount of charity care. Then insurance companies got into the picture.
They offered to pay for health care, if you, the patient, gave them money upfront.
They would then take that money, and invest it. They invested in the stock market,
and probably other areas. As needed, they’d liquidate some of those assets to
actually pay for medical services provided to their members.
They would make money when their investments did well, or if their patients did
not need as much in services as they paid in premiums. If their investments did
poorly, they’d raise their premiums. To this day, health insurance premiums reflect
the stock market more than they reflect medical advances or increases in health
care billing. Then the government got involved. Initially, the government paid for
services at a reasonable rate, and with few regulations. Over the years though, the
regulations have increased, and the reimbursements have dropped. The government
though is subject to the influence of lobbyists. Hospitals argued for more money,
pharmaceutical companies argued for more money. In many areas, not only the
hospitals, the reimbursements have not kept pace with costs. Hospitals, for
example, are required by law to treat anybody who shows up in their emergency
room, without regard to their ability to pay. As the stock market goes down, and
insurance premiums go up, the number of uninsured increases. To offset the
expense associated with treating the uninsured, hospitals increase the bills charged
to all of the paying patients. This means that the insurance companies need to pay
more to the hospitals. When they get to keep less of the money that they bring in,
what do they do? They raise premiums of course, then more people drop their
insurance, the hospitals charge more, and the cycle continues without a visible end.
The story is not over however. Insurance companies have found more ways to keep
more of the money that you send them. They designate some of their doctors as
“premium” doctors. This term implies higher quality. It really means less
expensive. Those doctors willing to work for less or who cost them less get the
designation as “premium” physicians. These are then marketed to large companies.
The large companies get a tax break for providing health insurance to their
workers. The employees get a small portion of that break on the cost of the
insurance. Of course, they get no choice of insurance companies. That decision has
been made, often on a financial basis, rather than quality basis, by the owners of
the company. The small business and the individual cannot negotiate with the
insurance company for lower rates, nor do they get a break on their taxes for
obtaining health care insurance. They get hit from both sides.
Only two more steps here. Now that the government is involved (in USA), they set
prices. Most insurance companies have now abandoned the “usual and customary”
in favor of a fixed percentage of Medicare rates. There is no other industry or
service in this country where the government sets the amount that is to be paid for

the product or service. As the government decides to spend less on health care, the
insurance companies get to keep even more of your premiums.
In most arenas, you get that for which you pay. If you want a good product, you
expect to pay a little more for it. In medicine, on the other hand, the government
sets the prices. (They often end up spending more for the care of a lesser quality
physician.) Still, the full responsibility for the care of the patient belongs to the
physician.
In many areas, not only the hospitals, the reimbursements have not kept pace with
costs. Hospitals, for example, are required by law to treat anybody who shows up
in their emergency room, without regard to their ability to pay. As the stock market
goes down, and insurance premiums go up, the number of uninsured increases. To
offset the expense associated with treating the uninsured, hospitals increase the
bills charged to all of the paying patients. This means that the insurance companies
need to pay more to the hospitals. When they get to keep less of the money that
they bring in, what do they do? They raise premiums of course, then more people
drop their insurance, the hospitals charge more, and the cycle continues without a
visible end.
BILLING PROCESS
The hospital billing process is:
(a) Preregister or register patients, including scheduling appointments and
establishing the patient's account;
(b) Establish financial responsibility for visits by explaining the facility's payment
policy to patients and verifying their insurance coverage and any precertification
requirements;
(c) Check patients in by copying their insurance cards and other identification
cards, collecting co-pays and/or deductibles, and obtaining the required consents
forms, such as a HIPAA Privacy Disclosure and the hospital's Notice of
Information Practices;
(d) Check patients out, providing them with post discharge care instructions if
required;
(e) Review coding compliance by checking the accuracy of the diagnosis and
procedure codes recorded in the patient's medical record and verifying that they are
logically connected;
(f) Check billing compliance by collecting the patient's charges accumulated
during the hospital stay and verifying them against the charge description master,
the patient's medical record, and knowledge of the payer's requirements;
(g) Prepare and transmit claims using the facility's patient accounting system,
including the use of a scrubberto test claims before transmitting them;

(h) Monitor payer adjudication to ensure that bills are paid on time and in full,
including claim follow-up and payment processing.
(i) Generate patient statements for remaining balances when health plan payments
do not pay the bills in full and for self-pay patients;
(j) Follow up on patient payments and handle collections, including writing off
uncollectible accounts. The first four steps deal with the patient's visit, the next
three steps with the patient's claim, and the final three steps with post-claim
activities.
During preregistration or registration, the following information is gathered and
entered into the patient accounting system to establish the patient's account:
personal data, basic billing data, medical information, an account number, and a
medical record number.
A routine charge is the total of the costs of all supplies that are customarily used to
provide the service. An ancillary charge is made for each specific service that is
used to treat the patient in addition to routine charges, such as for anesthesia and
blood administration.
The charge description master (CDM) is a computerized list of charge codes and
associated data for all services the facility offers. Each entry identifies the hospital
department and subcategory, the charge code for the service, the description, a
medical code (when required), a standard claim form revenue code (RC), and the
price. When the codes for services from the various charge slips are entered into
the patient accounting system, the code automatically posts the correct charge to
the patient's bill.
Billing errors include:
(a) Billing for services or supplies that are not documented in the patient's medical
record;
(b) Billing for services that are insufficiently documented in the patient's medical
record;
(c) Billing twice for the same service (double billing);
(d) Billing for medically unnecessary services;
(e) Billing for services that are included in other charges;
(f) Billing inaccurate information about providers or the wrong providers.
(i) Generate patient statements for remaining balances when health plan payments
do not pay the bills in full and for self-pay patients;
(j) Follow up on patient payments and handle collections, including writing off
uncollectible accounts. The first four steps deal with the patient's visit, the next

three steps with the patient's claim, and the final three steps with post-claim
activities.
During preregistration or registration, the following information is gathered and
entered into the patient accounting system to establish the patient's account:
personal data, basic billing data, medical information, an account number, and a
medical record number.
A routine charge is the total of the costs of all supplies that are customarily used to
provide the service. An ancillary charge is made for each specific service that is
used to treat the patient in addition to routine charges, such as for anaesthesia and
blood administration.
The charge description master (CDM) is a computerized list of charge codes and
associated data for all services the facility offers. Each entry identifies the hospital
department and subcategory, the charge code for the service, the description, a
medical code (when required), a standard claim form revenue code (RC), and the
price. When the codes for services from the various charge slips are entered into
the patient accounting system, the code automatically posts the correct charge to
the patient's bill.
The advantages of using information technology in the hospital billing process,
such as electronic health record (EHR) systems and electronic input devices during
the admissions process, are
(a) Immediate access to health information;
(b) Computerized management of physician orders;
(c) Access to research for decision making processes;
(d) Automated alerts and reminders;
(e) Electronic communications and connectivity;
(f) Patient supporttools suchas patient education on health topics;
(f) Administrative reporting tools;
(g) Error reduction.
The biggest disadvantages are
(a) The costof implementing the system
(b) The large learning curve for staff in becoming proficient with the new
technology;
(c) The potential risk to the confidentiality and security of patient data.
Hospital billing is the process of submitting and following up on claims with the
payer (patient, corporate or health insurance companies) in order to receive
payment for services rendered by a healthcare provider. To be precise

Step 1 The patient receives services at one of the hospitals.
Step 2 The patient receives an initial statement in the mail that includes visit
specific information (see below). - Charges for treatment and/or testing (itemized
statement available upon request) - Insurance information, if applicable.
Step 3 Hospitals’ Patient Accounting Department begins the billing and collection
processes based oninsurance information provided at the time of registration.
Step 4 If the account balance is not resolved in a timely manner by any insurance
company (third party payer), the patient may be billed.
Step 5 Patients may receive collection notices or statements from Hospitals’
internal and external collection sources. If a patient requires financial assistance,
there are Financial Assistance Programs available for those who meet eligibility
requirements.
The Importance of Hospital Billing
The medical industry is comprised of many divisions and sections which all work
together to offer patients a positive experience. This is true whether services are
provided through an emergency care centre, doctor's office or any of the many
types of medical help offices available. While many will focus on procedures
performed at various hospitals and treatment centers, medical service
administrative functions are equally as important, including hospital billing.
Hospital billing brings together charges based upon patient stays or procedures
performed at a hospital. By coordinating with doctors' offices throughout the
community, this financial department can ensure a smooth relationship between
doctors and patients. Because the medical billing process can be complicated, it is
important for all entities involved to check information and avoid any
discrepancies the patient might find.
While many hospitals employ their own accounting departments, the practice of
outsourcing accounting services has risen over the years. This practice can save
money while offering a more streamlined process to keep errors to a minimum.
Outside sources work hard to provide state-of-the-art technology that can keep
transaction costs down while eliminating problems such as fraud. Finding a service
that can balance the complexity of a medical network can be a cost saving option
that is valuable in economic down times.
In order to maintain a smooth accounting process, doctors should be willing to
coordinate their own billing practices with the medical community. If they choose
not to participate, errors might occur due to inconsistencies between accounting
sources. Doctors should consider being on the same system as community
hospitals in order to experience the bestvalue for money invested.

Many healthcare practice management companies exist to provide integrated
accounts receivable services for medical communities. Offering professional
services with highly experienced staff and management, they often provide a group
package at considerable savings that can encompass the entire community's needs
for consistent accounting and collections. Through proven success with the
companies they represent, healthcare billing services enable doctors and medical
services to focus on their patients' needs and provide excellent health care.
Medical accounts receivable services will cover all aspects of hospital billing. This
includes insurance transactions and follow-up as well as self-pay with follow-up
and third-party payments. All aspects of the process will be scrutinized and
followed through so that patients can enjoy a more relaxed experience at
potentially trying times. Allowing for a more personal patient/doctor relationship,
the right hospital billing service can work with the medical community to put an
end to financial headaches while making doctors' practices and hospitals'
procedures more profitable.
Keeping Finances in Order with MedicalBilling
Medical billing is extremely beneficial to the business. They can increase profits
and productivity, reduce collection times and successfully process claims all while
complying with regulations and standard government procedures.
Most medical billing caters to a wide range of services. These services typically
include statement mailing, workers compensation billing, collection and pre-
collection services, payment plan setup and monitoring and credit bureau
reporting. A company may also provide patient records services such as
transcribing, coding and record storage.
Medical billing should focus on staying up to date with coding, regulations and
new technologies that decrease the time spent per account. The staff are courteous,
competent and highly successful in the field. They will deal with the headaches
caused by insurance company requirements, saving your office from spending the
time necessary to handle common errors in an ever-changing system that seems
nearly impossible to keep up with. Luckily, since the specialists deal with these
scenarios every single day, the amount of errors within the claim are dramatically
decreased. Special software will also do a pre analysis guaranteeing that accurate
coding will allow the claim to process with no hassles. Code updates are done
regularly to maintain accuracy. The paperwork of claims processing is reduced due
to electronic recording and storage.

MedicalBilling Revenue - Reducing No-Shows
When patients miss appointments, they interrupt the flow of patient care and
impede clinic productivity. A missed appointment amounts to reduced billing and
missed revenue. The rate of no-shows runs at high for the average medical clinic.
Worse, if the clinicians are part-time or full-time staff rather than contracted, they
sit idle on the company clock. In this case, a missed appointment is not just a
missed opportunity for revenue, it's lost money with each passing minute.
An effective office manager uses three strategies to protectclinic revenue:
Charge for missed appointment: This strategy works well in terms of no-show
reduction for ongoing cases but it is ineffective for missed intakes. Billing full
service fees for misses is not possible for procedures covered by medical
insurance. In addition, billing insurance companies for services not rendered is a
major offence that carries severe disciplinary action including financial penalties.
Minimize no-shows: Recognize that any activity that reduces the frequency of no-
shows is a revenue-generating activity. Use down time to:
Make reminder calls for upcoming appointments: It works best when reminders
reach the consumers one to three days ahead of their appointments. Note that any
degree of success is improved billing and money in your pocket.
Follow up on recent no-shows: Call patients who failed to appear this week,
survey them as to the reason for their missed appointment, and reschedule next
appointment.
Analyze no-show statistics: Feed missed appointment survey information back
into patient scheduling system, alarming about the types of appointments that are
most likely to be missed. Use this knowledge to target reminder efforts, or to
change scheduling. For instance, waiting time for appointment is related to the
likelihood of missing it. Specifically, both very short turnaround times (one to
three days) and longer waits (10 to 14 days) are associated with poorer attendance.
Waiting periods of four to seven days positively correlate with best attendance.
Overbook: Overbooking is an effective strategy in terms of billing revenue
protection. It requires good understanding of your no-show statistics and it rests on
the premise of the interchangeability of clinicians. Identify the most vulnerable
appointment type in terms of missed revenue and cluster them during periods of
the day ("target periods") when you can have a pool of clinicians on site. You can

implement this strategy by scheduling appointments on the quarter-hour rather than
the half-hour increments during the target period.
MedicalBilling Service - the Services You Can Expect
Medical billing services are a blessing to medical practitioners that are hard-
pressed for time and resources. They take over the burden of billing and related
administrative tasks from the healthcare provider and increase their revenue.
Medical billing services are quickly becoming the industry standard because of the
many advantages they offer.
Medical billing services offer both claim submissions and comprehensive practice
management solutions. Generally, small organizations that are either home-based
or small scale offer only simple billing services. Larger practice management
companies offer comprehensive packages that promise long-term benefits for the
practice. These services can offer anything from advertising to scheduling
assistance, and much more. Depending on your organizational needs you can hire a
provider who offers suitable services. The services are broadly categorized into
standard services, extended services and practice management services.
Standard billing services
These are the minimum any medical billing provider offers. These include:
Claim submissions: Billing providers use medical billing software to submit
claims. The patient demographics, encounter data, and insurance details are entered
into the application that is programmed to validate the claim for accuracy.
Accurate claims reduce the chances of claim rejection by the insurance company.
The validated claim is submitted to the insurance company electronically within 24
hours.
Regular follow-up of claims: This is where medical billing providers prove their
mettle. They follow up on the claim aggressively and tenaciously. The medical
practice reaps the rewards of this strategy by receiving more payments on time.
Analytical reporting: Billing services capture and project key statistics in
monthly reports. The reports can help business heads of the medical practice take
steps to improve the growth, productivity and cost-savings in the establishment.
Patient billing and enquiries: Billing services take care of the logistics of the
billing function, and assist in patient enquiries.
Extended billing services

These take on responsibilities that are not directly related to the billing process.
They include:
Diagnosis and procedure coding: Billing providers do the medical coding for the
patient record before it is entered into the medical billing software application.
Medical transcription: Medical transcription is done before the medical coding
stage. Many billing providers offer transcription as an administrative service.
Practice managementservices
These offer holistic services that overhaul the medical practice's administration.
Services include:
Financial services: Financial services start with claims collections and move on to
accounting, tax planning, budgeting, accounts payable and more.
Negotiation of contracts: Billing providers have the necessary expertise to
effectively negotiate with hospitals and managed care representatives. Medical
providers can leave this task to the billing providers with confidence.
Human resource services: Medical practices can outsource human resource
functions such as payroll, staffing, incentive programs, and employee contracts to
medical billing providers. Medical billing services enable medical practitioners to
focus and improve on patient care, without worrying about outstanding
receivables. Billing services take away the burdensome administrative tasks related
to insurance claims and revenue management and promise an increase in revenue.
Simple MedicalBilling Processfor the Patients
Hospital is the place that many people hope to find some cures for their illness. As
we know, each day, there are thousands of people that a hospital must handle. As
an institutions that involved many systems including some costing systems, the
hospital also need some excellent billing services. It's not only about the systems,
but it needs the excellent operators too. The billing system in a house is a very
complicated system. There are so many kinds of systems that involved and being
fused into the billing systems. The medical billing process is something
complicated.
There are many sectors' billing statements that must be handled by the medical
billing systems. The medical billing process is also about many kinds of costing
process that involved each departments of the hospital. All those departments
billing systems will be integrated to the whole hospital medical systems in a very
complex billing process that must be perfectly handled by the hospital's accounting
departments. But contrary with the complex medical costing process, the process
from the patients must be simplified. It means, the complex process should only
happen inside the management and the patients must not have to deal with those
complicated systems.

Process Improvement in OPD billing by observing Billing Errors and thereby increasing patient satisfaction

Process Improvement in OPD billing by observing Billing Errors and thereby increasing patient satisfaction

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