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Healthcare Finance & AccountsCase 06 of 10Illustrative engagement

Revenue cycle and insurance reconciliation

A mid-sized hospital

  • RegionGujarat
  • ScopeMonthly
  • TimelineOngoing
  • MarketsIndia
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Illustrative engagement. A representative scenario showing how we approach this kind of work in healthcare. It does not describe a specific client; outcomes are described qualitatively.

01

Industry overview

What is shaping healthcare

Hospitals, clinics, diagnostics and health-tech companies need evidence from patients and professionals, gathered with verified respondents and strict privacy.

  • Patients compare providers online
  • Diagnostics and telemedicine are growing
  • HCP opinion shapes referrals
02

Client background

A mid-sized hospital, working in Gujarat. This is an illustrative engagement: a representative scenario showing how we approach this kind of work, not a named client project.

Organisation
A mid-sized hospital
Sector
Healthcare
Team engaged
Finance & Accounts
Services
Accounting & bookkeeping, MIS & financial reporting
03

Client challenge

Insurance claims were often delayed or short-paid, and the hospital lacked visibility of outstanding amounts.

04

Research objectives

  • Deliver on the brief: revenue cycle and insurance reconciliation.
  • Establish accurate, reconciled numbers management can rely on.
  • Put a reporting and compliance rhythm in place that runs on time.
05

Target audience

Scope: Monthly.

Audiences we typically reach in healthcare

Patients and caregiversDoctors and specialistsNurses and staffDiagnostics customersHealth-tech users

06

Geographic coverage

Coverage: Gujarat. Market: India.

  • India
07

Research methodology

A structured finance engagement: review the current process, set up controls, run the routine and report.

  1. 1Brief
  2. 2Claim reconciliation
  3. 3Monthly MIS
  4. 4Insight

We reconciled claims against payments, tracked deductions by insurer and produced a monthly receivables report.

Accounting & bookkeepingMIS & financial reporting

08

Sampling strategy

  • Every ledger, entity and transaction stream in scope was covered, with sample-based checks during review.
09

Data collection

Discovery Plan & design Build / execute Test & refine Launch & handover Indicative phasing.
  • Source documents, bank statements and ledgers were collected through a secure shared workspace.
10

Data quality & validation

  • Maker-checker review on all entries
  • Bank and ledger reconciliations
  • Client approval before every filing or report
  • Supporting documents kept for every figure
11

Data analysis

  • Variance analysis against budget and prior periods
  • Ratio and trend analysis
  • Cash-flow view for management
12

Key findings

  • Unreconciled claims are lost revenue.
13

Recommendations

  • Build on the core insight: unreconciled claims are lost revenue.
  • Keep the monthly routine and review exceptions with management every period.
14

Business impact

  • The hospital followed up deductions systematically and reduced long-outstanding claims.

Impact is described qualitatively.

15

Deliverables & next steps

  • Insight report and management presentation
  • Monthly MIS pack and reconciled books
  • Compliance calendar and filings
  • Continue the routine and review results every period.
  • A natural follow-on question: where does the journey break?

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