Indian private hospitals still lose 4‑6 % of revenue to sluggish claim cycles and under‑coded procedures. The bottleneck is rarely medical expertise; it’s fragmented paperwork flowing between hospital billing desks, third‑party administrators (TPAs) and half‑digital insurers.
The numbers
Average time from discharge to claim submission: 10.6 days (NABH audit, 2018).
Weighted cost of capital for mid‑tier hospitals: 12‑14 %. Every extra week in accounts receivable eats roughly ₹8 cr per ₹1,000 cr topline.
Manual “short payments” from insurers average 11 % of claimed amount in orthopaedics and cardiology.
Fixes that pay for themselves
Structured discharge summaries generated inside HIS, mapped to ICD‑10 and CPT equivalents, cut first‑pass edits by insurers to <3 %.
Robotic process automation for TPA portal uploads: ₹40 lakh capex for a 400‑bedter; payback ]<11 months.
Dynamic credit‑control dashboards that show CFOs “denial hot spots” by consultant, package, and insurer.
Finance teams willing to fund back‑office software instead of new MRI suites can free up working capital for higher‑yield growth projects without dipping into expensive debt.