Increasing Patient Flow Through Acceptance of Health Insurance

Introduction

The healthcare financing system is increasingly transforming, and healthcare organizations should take this chance to reinvent their delivery models to optimize services and remain financially viable. The topic for this submission is one of the critical challenges that our dental clinic in Dubai, United Arab Emirates, is currently facing. At this moment, our clinic is financed on a cash basis alone, thus denying medical care to a significant section of our population. This will lead to offering a wide range of dental services and coverage of medical insurance plans. This opportunity is in sync with the clinic’s policy of supporting patient accessibility and care delivery equality.

Scope and Objectives

The proposed program aims to turn the payment system at the dental clinic from cash-only acceptance to accepting different insurance plans accessible to the broader society. The operational shift in strategy is complementary to the mission of an inclusive healthcare provision in the community and necessary for its improvement. The solution framework is focused on a payment overhaul that will enable insurance billing – the first step towards a patient-centric, leading service delivery approach.

The key to the success of this venture is our SMART targets (Hales, et al 2022). The first target is to increase the traffic of the patients by 20% over the next half year after the implementation of the cashless healthcare option, which will expand the clinic’s reach and attract customers who have yet to come due to the cash-only policy. This is a quantifiable goal, which makes it more clearly understandable, and it depicts the clinic as having a more significant focus on serving a diverse population.

One of the key objectives is to enlarge the provider profile by focusing on individuals with targeted health insurance plans. With This payment option diversification strategy, the clinic wishes to attract patients from employers and government-sponsored health insurance, thereby widening the scope of health care services to all people irrespective of socioeconomic status, inclusion, and service delivery. This goal matches the clinic’s ethos of allowing for easy access to healthcare services and makes sustaining the clinic financially more accessible by generating new revenue streams.

The aim of stretching revenue streams through insurance reimbursements collapses the financial benefits of the proposed interventions. Billing for insurance arrangements, the clinic generates more payments than traditional cash payments. This objective aims to strengthen and stabilize finances to make capital investments in providing the best services possible and better facilities, equipment, and staff training.

Finally, not only is the objective of increasing overall patient satisfaction important, but it is also essential to provide an easy and enjoyable patient experience. Among other things, the clinic would improve consumer satisfaction levels by offering flexible payment options with health insurance. Continuous patient feedback will guide the clinic in reevaluating its performance and fulfilling its requirements.

Risks and Constraints

In implementing the transition to accepting health insurance, several risks and constraints need to be addressed to ensure the smooth operation of the new system.

Initial Administrative Burden

One of the biggest problems when the clinic staff processes insurance claims is that, at first, this is always a heavy administrative load for clinic staff. The changeover might be accompanied by the need for more personnel to help with the intricacies of the insurance segment, namely, verifying the cover, submitting the proper claims, and understanding the systems and procedures of each insurance company (Hoicka, et al 2022). This added workload has a potential for resource exhaustion; therefore, new funds are likely to be requested to train the staff or hire new administrative staff to ensure a smooth transition.

Potential Delays in Reimbursement

However, another risk exists related to delays in receipt of payments from the insurance companies. Bilingualism and its Benefits on Language Acquisition Insurance service providers frequently have set deadlines and procedures to acknowledge the claim that can drag the service payment for weeks (Bunni, et al 2022). The delays in receiving payments may result in cash flow problems for the clinic, especially if it has just started making payments with insurers. The prevention of this risk consists of setting up effective submission and follow-up processes and reconciliation that will, in turn, reduce the waiting time for claims to process.

Compliance with Insurance Policies and Regulations 

It is also essential to follow policies and laws and avoid legal or financial losses. The lesser insurance provider could differ in their enlistment terms for claim submission, documentation, and reimbursement (Talesh, 2018). Non-compliance with these rules can cause the clinic to refuse to implement them, reject claims, and even file fines or lawsuits against them. To avoid this risk, the clinic must be updated on insurance companies’ policies and regulatory affairs. To prevent non-compliance, operating through robust compliance protocols and continuous training of staff members will be one of the key goals in the clinic.

Technology and Infrastructure

The transition to health insurance bills should also have corresponding technical infrastructure, and all of them can serve that function. It even means investing in newer software programs, which may improve the network or involve integrating third-party billing systems. These obligations must be stipulated and observed to avoid bad records and protect the user’s data.

Patient Education and Communication

Moreover, patient confusion or dissatisfaction can also arise from billing process problems. The patients might be concerned about whether they are now taxed, whether the services may be covered, and how they affect the out-of-pocket costs. Besides, one of the primary goals of adequate education and communication on this issue is to ensure the smooth adjustment for a proper patient (Wittink, and Oosterhaven, 2018). This includes giving patients detailed, clear, and well-informed information about insurance coverage, billing procedures, and payment options and offering support and assistance to the patients who experience the new systems.

The strategic approach towards identifying and dealing with these limitations is the primary tool that can prevent additional difficulties and make the health insurance process less complicated (Atrill, & Mc Laney, 2019). This is why efficient preparation with budget allocation, skilled staff training and education, and patient communication are mandatory. By effective risk management strategies, the clinic will be able to get the benefits of a more extensive patient base and financial stability without compromising on the service quality and following the body’s regulations.

Financial/Budget Impact Analysis

Resources Impacted

Personnel

Additional Administrative Staff: The clinic will take the initial step by signing up additional workers whose role will be to cater for the extra work generated by the insurance claims. They will be fulfilling duties, including coverage validation, claim submissions, and payment reconciliation.

Infrastructure

Billing System Adjustments: Software updates may include modifying software for electronic claims submission and integrating it with social systems for insurance providers. These readjustments will ensure the smooth handling of claims with no changing layout in the existing structure.

Patient Records Management: It is essential to ensure that patient records are updated correctly and include any required insurance information to ensure unhindered billing (Sugiarti, 2020). It includes automating precise reimbursement information, determining coverage details, and eligibility verification tools in electronic health records systems.

Training

Staff Training: Comprehensive training programs will enable the existing staff to be well versed in all the insurance billing procedures, thus equipping them to handle the same confidently. Topics of training may include insurance coverage policy, proper documentation of claims, and determination of billing-related inquiries.

Revenue

Expected Increase: Given that we will accept health insurance for the clinic, I fully expect its revenue to rise substantially as it will receive several reimbursements from the insurance company (Finkler, et al 2019). This extra source of income will enhance the financial independence of the clinic, and therefore, there will be money left for improving the clinic facilities and services.

Cost Analysis

Administrative Staff (AS) 

The estimated cost of AED 6,000 per month for adding employees to administrative staff denotes the financial investment necessary for augmenting insurance claims processing (Yelnikova, and Kwilinski, 2020). This investment will increase the level of recurrent costs that the clinic will incur. Still, it will mean that the clinic is prepared to invest resources efficiently in implementing the proposed change.

Software/System Upgrade (SU)

Around AED 10,000 for software/system upgrades is a one-time expense to bring the clinic’s technological outlook to the highest standard. This upgrade will safely ensure the transference or integration of insurance billing capabilities into the system to allow easy and efficient management of insurance claims and smooth administrative processes.

Staff Training (ST) 

Training intervention is essential to the implementation, costing about AED 4,000. Therefore, it is considered a high-priority thing to allocate. Along with the financial resources invested in the clinic’s training sessions, there could be a chance for the clinic’s competent workforce to manage insurance billing (Jongen, et al 2018). By making this investment, the clinic means its commitment to improving the practice capability and the staff’s professional advancement through which the best services of the clinic can be achieved.

Impact Evaluation

Financial Impact

Anticipated Increase in Revenue: The prospect of reimbursing insurance payments is a significant reason why the health clinic anticipates a boost in revenue when it transitions to accepting health insurance (Collier, 2009). The clinic can constantly explore other revenue biggers besides the cash payments to create a more solid base for finance and improve profitability. This foresighted revenue boost is an undeniable impetus for adopting a new billing system and a lively expression of the ensuing financial gains the treatment will bring.

Initial Investment in Staff Training and System Upgrades: Although there might be initial expenses like staff training and data processing equipment upgrades for adjusting the insurance-related functionalities, this investment will yield financial returns over time. Initial costs related to the training measures, software adjustments, and technical infrastructure are invaluable investments that guarantee a smooth shift toward the new invoicing method. Eventually, the clinic will convert the initial expenditures into profit, generating more revenue and operating effectively.

Clinical and Organizational Impact

Improved Patient Access to Dental Care: Therefore, insurance enrollment can be considered as the vehicle of poising dental care accessibility for patients into the broader picture, which results in the oral health records of the population. Nowadays, with dental care services that are considered unaffordable because of the financial impossibilities of patients being insure-funded, particular patients can now have their most pertinent dental procedures done through their insurance. Finally, the clinic provides a wide range of services and is free of charge. Hence, the clinic achieves its aim of providing oral health services and the creation of a healthy community.

Enhanced Clinic Reputation and Competitiveness: Our clinic has now transformed into billing for health insurance, the image has improved, and the clinic has come closer to the market. The clinic is responsive to the patient’s needs through multiple payment systems, such as standard and the industry’s best practices (Al-Habib, et al 2022). Through proactive financial management and delivery of service strategy, the dental clinic assumes the front-row place in the dental healthcare industry, steering more clients and existing ones toward it.

Streamlined Billing Processes: TransitioningTransitioning from regular billing to health insurance may reduce billing workload to the extent that improvement in daily operational efficiency becomes a reality. Through automatic submission of claims, processing, and reimbursement procedures, the clinic can dispense with many administrative jobs and reduce the number of errors that often happen in manual billings. This development in productivity only saves time and energy, resulting in better performance in the clinic’s function.

Recommendations

Prioritize Staff Training: With the concentration on training, the staff will have good knowledge of the insurance acceptance rules, which will help them to perform their tasks error-free. Thus, they will be able to follow the billing process smoothly.

Establish Clear Communication Channels with Patients: Talking to the patients about the coverage of insurance and billing processes in a way that fosters their confidence and a way of managing their expectations ends up in a positive experience and with more than reduced conflict or disputes (Varadarajan, et al 2022).

Monitor Reimbursement Processes Closely: Tracking the reimbursement process allows the clinic to move immediately and solve any delays or problems in the process that would ultimately cause slow cash flow, which might threaten the financial stability of the clinic or even result in patients’ dissatisfaction due to the left unattended billing issues.

References

Al-Habib, F., Al Abdulbaqi, F., Alibrahim, H., Alhamdan, Y., Nazir, M.A. and AlHumaid, J., 2022. Physicians’ awareness of oral-systemic links and its association with physician-reported patient referral to dentists. Plos one, 17(10), p.e0276479.

Atrill, P & Mc Laney, E., (2019). Accounting and Finance for Non-Specialists (10th Edn). Pearson ISBN-10: 1292244011

Bunni, N.G. and Bunni, L.B., 2022. Risk and insurance in construction. Routledge.

Collier, P., (2009). Accounting for Managers: Interpreting accounting information for decisionmaking (3rd Edn), Chichester: Wiley

Finkler, S., Kovner, C., Jones, C., (2013). Financial Management for Nurses Managers and Executives (4th Edn). St. Louis: Saunders.

Hales, D. and Lauzon, L., 2022. An invitation to health. Brooks/Cole.

Hoicka, C.E., Lowitzsch, J., Brisbois, M.C., Kumar, A. and Camargo, L.R., 2021. Implementing a just renewable energy transition: Policy advice for transposing the new European rules for renewable energy communities. Energy Policy, 156, p.112435.

Jongen, C., McCalman, J., & Bainbridge, R. (2018). Health workforce cultural competency interventions: a systematic scoping review. BMC health services research, 18, 1-15.

Sugiarti, I., 2020, June. Legal protection of patient rights to completeness and confidentiality in management of medical record documents. In 2nd Bakti Tunas Husada-Health Science International Conference (BTH-HSIC 2019) (pp. 179-191). Atlantis Press.

Talesh, S.A., 2018. Data breach, privacy, and cyber insurance: How insurance companies act as “compliance managers” for businesses. Law & Social Inquiry, 43(2), pp.417-440.

Varadarajan, R., Welden, R.B., Arunachalam, S., Haenlein, M. and Gupta, S., 2022. Digital product innovations for the greater good and digital marketing innovations in communications and channels: Evolution, emerging issues, and future research directions. International Journal of Research in Marketing, 39(2), pp.482-501.

Wittink, H. and Oosterhaven, J., 2018. Patient education and health literacy. Musculoskeletal Science and Practice, 38, pp.120-127.

Yelnikova, Y.V. and Kwilinski, A., 2020. Impact-investing in the healthcare in terms of the new socially responsible state investment policy.