The Development Guideline for Revenue Collection Using a Receivable Claim Management (RCM) Progam at Health Network, Roi-Et Province

Abstract

Purposes : This study aimed to investigate the challenges, develop strategies, and evaluate approaches for revenue collection management using a hospital debt management program within the Roi Et Provincial Health Network.

Study design  : A mutual collaborative action research methodology was employed.

Materials and Methods : Key informants included: (1) 32 personnel responsible for revenue collection centers in community hospitals during both the situation assessment and service system development phases; (2) 2 officials in charge of revenue collection at the Roi Et Provincial Public Health Office; and (3) 21 key personnel, including heads and staff managing revenue collection services in community hospitals within the network. The study was conducted from January to December 2024. Data were collected using questionnaires, focus group discussion guides, record forms, and analyzed through frequency, percentage, mean, standard deviation, and %Difference.

Main findings: 1) Situation analysis: The primary challenges identified were categorized into six domains: management systems, personnel, patients/public, technology, policy and legislation, and monitoring and evaluation. Overall, the operational management of debt collection was rated as inadequate. 2)Proposed revenue collection strategies: The development framework included (1) restructuring the revenue collection system, (2) enhancing operational processes for billing across all funds, (3) increasing the number and improving the skills of responsible staff, (4) ensuring complete and accurate recording and review of medical procedures and treatments, (5) timely and precise coding of procedures and treatments, (6) Implementing ongoing oversight of fund-specific reimbursement systems, and (7) evaluating outcomes and facilitating knowledge exchange post-implementation, and 3) post-Implementation outcomes: After system improvements, the debt management efficiency scores increased in 12 hospitals (10.16%), decreased in 7 hospitals, and remained unchanged in 1 hospital.

Conclusion and Recommendations: This research led to an enhancement in debt management efficiency and Total Performance Score (TPS) across the network. Relevant stakeholders are recommended to adopt the developed system to optimize revenue collection management and improve operational efficiency.