Glosses: many managers may be losing money without knowing it. However, measures can be taken to avoid this damage.
The greatest risk of financial losses for a clinic is in receivables, because health insurance companies have historically known about the lack of control of clinics in general to control the receipt of each exam. The glosses in supplementary health were 5,92% in 2021, according to data from the National Supplementary Health Agency (ANS). This means that, a clinic that earns, per year, R$ 16 million, loses almost R$ 1 million of net profit in glosses!
“For the managing physician, it is difficult to notice the glosses if he does not have a good process, good control. So, the feeling, at first, is to believe that there is no problem with glosses in the clinic. The truth is that we all have a gloss”, said the economic adviser of the Brazilian College of Radiology and Diagnostic Imaging (CBR), Carlos Moura, during his participation in the “Estúdio ABCDI” program that addressed the issue.
Presented by the director of the Brazilian Association of Radiology and Diagnostic Imaging Clinics (ABCDI), Luís Ronan Souza, the “Estúdio ABCDI” with the theme “Glosas Who are they, where do they live and how do they reproduce?” is available on association website.
“Glosa is not just the Demonstrative of Gloss. Often, when you speak in gloss, the person says that he received a statement and appealed. But we are talking about a whole chain of loss, which starts with the values met, a part of which is already lost in pre-invoicing, when the invoice is issued to be able to enter receipt, another part is lost, here comes the statement from the paying source to reconcile, one more part is lost and what is actually received is the last part.”
Carlos Moura, economic advisor at CBR, professor of the Clinical Management course at ABCDI, business administrator with an MBA in IT from USP and an International Course on Human Talent Development from the University of Central Florida
Predictability and planning
Effective tools are essential for preparing and monitoring the revenue budget, cost and expense budget, Cash Flow and EBITDA.
To combat glosses, radiology and diagnostic imaging services must implement a process to control 100% the values met to ensure revenue and outline continuous improvement plans to reduce future glosses.
CBR's economic adviser explained: “The Receivables Macroprocess is of great importance, but it has received little attention from clinic managers, not due to ignorance of risk, but due to the complexity and impossibility of resolving the volume of discrepancies that appear every day. . It involves factors such as: Patient Eligibility, Authorization, Check 1 – Attendance, Check 2 – Billing, Solving Pending Issues, Check 3 – Billing, Invoice Issuance, Conciliation, Gloss Resources and Accounts Receivable”.
ABCDI: partner of the clinics in the fight against glosses and for more efficient management
With more than 20 years of experience, the Brazilian Association of Radiology and Diagnostic Imaging Clinics (ABCDI) is a partner in the fight against glosses. In addition to addressing the issue in lectures, presentations and at Estúdio ABCDI, the association has one of the modules of its Clinic Management course focused on the segment with the theme “Implementing Financial Management Tools”.
With open positions, the course teaches, in a practical way, how to implement an excellent process controlling 100% of the values met to guarantee revenue and draw up continuous improvement plans to reduce future disallowances.
The syllabus of Module 4 of the ABCDI Clinic Management course includes:
Receivables Management Processes and Tools
– Supplementary Health Receivables Scenario
– Main Steps of the Receivables Macroprocess
– Reconciliation of Payment Statements and Glosses
– Implementation of the Gloss and Collection Appeal Process
EBITDA Calculation and Management Adjustments
– EBITDA Objective and Its Positives and Negatives
– Cash Regime X Accrual Regime
– Concept of Depreciation
– Fundamental Concepts about Costs and Expenses
– The Importance of the Chart of Accounts Structure
– Main Account Groups
– Adequacy of the Clinic Accounting Plan
– Definition of the Structure of the DRE (Statement of Economic Income)
– Calculation of EBITDA and Market References
Preparation and Application of the Revenue Budget
– Importance of Revenue Budget
– Methodology Used to Increase Effectiveness
– How to Prepare the Revenue Budget (step by step)
– Monitoring Budget Achievement During the Year
Elaboration and Application of the Budget of Costs and Expenses
– Key Points for Budgeting
– Success Factors in Implementation and Recurring Errors
– Analysis of the Main Groups of Accounts
– Budget Simulation Tool
– How to prepare the Costs and Expenses Budget
Preparation and Application of Cash Flow
– Importance of Cash Flow in Clinics
– Relationship with Financial Institutions
– Cash Flow Assumptions
– Cash Flow Analysis and Views
– How to Prepare the Cash Flow (step by step)
– Investment Simulation Using Cash Flow
Calculation of Costing by Absorption by Modality
– Methodology to calculate EBITDA by Mode
– Variation in Value per Item Produced in Different Modalities
– Apportionment needs and their variations
– Logic of Apportionment of Indirect Costs and Expenses
– How to Elaborate Absorption Costing (step by step)
Clinic Loan and Debt Management
– Learning to Work with Third Party Money
– Consolidation of Financing and Loans
– Negotiation of Loans and Debts
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