Healthcare
Finance for clinics and hospitals, where the payer decides the cash cycle
A hospital's revenue is recognised at discharge and collected whenever the payer decides. We build the reporting and controls around that gap: TPA ageing, disallowance tracking, doctor payouts that reconcile, and department-level contribution.
The payer decides the cash cycle.
Cash · insurance · third-party administrator
At a glance
Third-party administrator receivables are tracked as one balance rather than aged by case.
Revenue and collection
Payer mix and case-level receivable ageing.
The economics
Why the numbers are harder here
Healthcare providers carry an unusual disconnect between service and settlement. Cash patients pay at discharge; insurance and third-party administrator cases are billed, queried, partly disallowed and settled months later. A single reported revenue figure covering both conceals a working-capital position that can be very different from what it looks like.
Underneath that sits a cost base split across departments that share almost everything — theatre time, nursing, equipment, consumables — which makes department-level profitability a question of allocation discipline rather than arithmetic.
The problem
Where visibility breaks down
- Third-party administrator receivables are tracked as one balance rather than aged by case.
- Disallowances are absorbed at settlement, so nobody knows which cases or payers cause them.
- Doctor revenue-share payouts are computed from a working file that does not reconcile to billing.
- Pharmacy and consumables stock is counted for operations and not agreed to the books.
- Department profitability is not computed, so cross-subsidy is invisible.
Where we concentrate
How we focus the engagement
Revenue and collection
- Payer mix reported explicitly: cash, insurance and third-party administrator.
- Case-level receivable ageing, not a single payer balance.
- Disallowances analysed by payer and reason, so the pattern is addressable.
- Billing reconciled to the clinical record, so nothing delivered goes unbilled.
- Credit and discount authority defined and applied consistently.
Cost and department control
- Department-wise contribution, with shared costs allocated on a stated basis.
- Doctor payouts reconciled to billing before release.
- Pharmacy and consumables inventory agreed to the books on a fixed cycle.
- Equipment capital expenditure evaluated against actual utilisation.
- Payroll and roster cost measured against activity.
Reporting
Reports worth receiving
- Payer mix and case-level receivable ageing.
- Disallowance analysis by payer and reason.
- Department-wise contribution.
- Doctor payout reconciliation.
- Pharmacy and consumables stock position, with expiry exposure.
Common questions
Questions we hear in this sector
Do you advise on clinical or medical matters?
No. Our work is the finance function — billing reconciliation, receivables, payouts, inventory, costing and controls. Clinical, regulatory and licensing matters sit with the appropriate professionals and authorities.
Can you work with our hospital information system?
Yes. The usual gap is between the hospital system and the accounting system rather than inside either, and that handoff is generally where the reconciliation work lies.
How do you handle doctor revenue-share arrangements?
By reconciling the payout computation back to billing before it is released, and documenting the basis of each arrangement so the calculation can be checked rather than trusted.
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