Pratik TPA and Corporate FINAL

7/30/2019 Pratik TPA and Corporate FINAL

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Major Project on TPA and CORPORATE

Department of Nightingale Hospital

Submitted by- Pratik Chakraborty

Semester- 6th

George College

Roll- 13303310070

Registration n0- 101331310029


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The survey work has been done on the various dept. of Nightingale Hospitals, their activities,

their way to administration & the ways to handling problems etc. It gives me immense pleasure

& satisfaction to express my heartfelt & sincere thanks to all those who directly & indirectly

helped me in the successful completion of my project.

First of all I would like to convey my gratitude to Mr. Tirthankar Ghosh (Public relation

Manager) for giving me the opportunity to undertake my training at Nightingale Hospital &

thus providing me a chance to take a part in a very important & much awaited hospital endeavor.

I also express my sincere thanks to Mr. Abhishek sen (Asst. manager Operations), & other

Managers & Executives of all the department of Nightingale hospital, Kolkata who helped

and inspired me to complete this project & extended all co-operations whenever I needed it.

I want to thank our our Faculty of HospitalManagement, George College, Kolkata, Mrs.

Anindita Sarkar & Mrs. Gargee Lahiri for giving me an opportunity to undertake my training

at the Nightingale hospital, Kolkata; and for constant help encouragement and constructive

guidance during the course of my study, without which I could not have completed this project.I would also like to thanks Ms. Manali Das (Placement Officer, George College) & Srabosti

Ghosh (Head of the Department) for extending their support, guidance, best wishes &

influences throughout the period of my major project.

Last but not the least, I would like to convey my deepest & most sincere gratitude to my parents

for supporting the through thick & thin & encouraging me in pursuit of higher education.

Thank you. Pratik Chakraborty


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To Whom It May Concern

This is to certify that Mr. Pratik Chakraborty, studentof Bachelor in Hospital Management , 6th Semester,Roll No.- 1013310070, Registration No.- 13303310029,have worked under my direct guidance & supervisedfor the summer training project on variousdepartments of Nightingale hospital.

He is hereby permitted to submit the project for thepartial fulfillment of Bachelor of HospitalManagement 5th Semester curriculum of West BengalUniversity of Technology.

Date: Signature


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TPA is the short form of Third part administrator. It works as a mediator between the

hospital & Health insurance Company. The person who is under health insurance policy,

they and their family get benefits in case of illness in networked hospital. They authorizean amount for the treatment of the patient, on the basis of hospitals estimate bill. TPA

works between the hospital & insurance company. There are two types of facilities of

treatment.

CORPORATE are the companies, which are directly tied with us. The employees &their families get benefit from us in case of their illness.The government employees, who are enlisted under West Bengal health scheme, they

also get the benefit.

I observed the department for 2 months. The department works for the patient, who is

under cashless treatment, health insurance, mediclaim.

In case of TPA, the hospital sends documents and disease history of the patient to

TPA, for cashless approval.


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I was in the department during my internship. Every employee helped me in collecting data and

helped me a lot. But there I found some limitation in the department like--

o Lack of space in TPA & Corporate departmento Tie up with limited some third party administero Not signed in PPN.o Lack of information and communicationo Middle level marketing plans.


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CONTENTS

TOPIC PAGE NOINTRODUCTION 7

OBJECTIVES 12

REVIEW OF LITERATURE 13

METHODOLOGy.. 15

Data collection

Data analysis

PROBLEMS 20

RECOMMENDATION .. 21

CONCLUSION. 22


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TPA is the short form of Third part administrator. It works as a mediator between

the hospital & Health insurance Company. The person who is under health

insurance policy, they and their family get benefits in case of illness in networked

hospital. They authorize an amount for the treatment of the patient, on the basis of

hospitals estimate bill. TPA works between the hospital & insurance company.

There are two types of facilities of treatment.

TREATMENT in TPA case

1) Cashless treatment2) Reimbursement treatment

Cashless treatment-

Both individual and corporate policy holders get benefit from their networked

hospital when they get admitted for any treatment with their valid documents.

Hospital authority needed to send the entire will to the particular TPA for payment

after a certain time. TPA Company sends the amount to hospital through cheque or

NFT/ECS .this is called cashless procedure. This process is most popular in today

for patient.


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Reimbursement treatment-

This is another type of treatment for health insurance patients. There is no

limitation in this system. Any policy holder (individual and corporate) can avail

this type of treatment to any hospital. Here patients come, & admit directly. He

pays the bills after discharge by cash or cheque. After discharge, the hospital

provides sufficient document to the patient that he can claim the amount he has

paid, to insurance company or TPA or Corporate. Here hospital doesnt take any

headache for payment and patient. After a certain time the patient gets return the

amount. West Bengal health scheme is the proper example of reimbursement.

ADMISION PROCESS

There are two types of admission of patients.

1) EMERGENCY ADMISION2) PLANNED ADMISION

EMERGNCY ADMISION-

In case of accident or in emergency treatment, we admit the patient immediately

showing his TPA card. After admission, patient party come and submit valid

document. Then we prepare an estimate bill on the basics of doctors consultation

& TPA provides authorization letter to us and the process goes on.


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PLANNED ADMISION-

When the patient is aware about his treatment or doctor advice the patient for admission

for treatment, then the patient comes & above process goes on. Its called plannedadmission.

Documents required for admission in mediclaim case are-

1) Patients address proof and ID2) Previous diagnosis report3) Doctors prescription4) Admission advice letter5) TPA card6) In case of individual policy, insurance paper7) In case of corporate policy, corporate id proof

CORPORATECORPORATE are the companies, which are directly tied with us. The employees

& their families get benefit from us in case of their illness. The corporate patients cometo the hospital with a credit letter from his/ her company and get treatment in IPD andOPD at free of cost.

The government employees, who are enlisted under West Bengal health scheme, theyalso get the benefit.


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We work with various CORPORATE. They are as follows

1.Clinical Research

2.Hindustan Cooper

3.SBI Russell street

4.TATA Motors

5.WIPRO Consumer care

6.Reserve Bank Of India

7.Air India

8.Mc.Nally Bharat

9.Middleton lease holders

10.Steel authority of India

11.ONGC

12.Hindalco

13.TATA Steel

14.Glaxo SmithKline

15.SBI Zonal

16.Modern

17.Nirnoy

18.L&T

19.IDBI Bank

20.NALCO

21.Cresing corporation ltd

22.Coal India

23.WOCKHARDT

24.Appolo TYRES

25. Mohonbagan athletic club


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The hospital works with many third party administrators. They are as follows..

1.Dedicated healthcare services

2.Medsave

3.Raksha

4.Medicare

5.Vipul

6.Heritage

7.Genins

8.Med assist

9.TTK healthcare private ltd

10.MD India

11.Medi Assist

12.FHPL

13.E Meditek

14.United Parekh India private ltd

15.Alankit healthcare TPA

16.Health India


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TO OBSERVE AND LEARN FROM THE DEPARTMENT. TO KNOW THE DIFFERENT PACKEGES OF THE HOSPITAL. TO KNOW THE WORKFLOW OF TPA & CORPORATE DEPARTMENT TO KNOW THE PATIENT SATISFACTION RATE FOR CASHLESS TREATMENT. TO FILL UP THE QUESTIONER FROM THE OF PATIENTS. TO SHOW THE SPECIALITY OF THE HOSPITAL. TO OBSERVE ABOUT THE MARKETTING PATTERN OF THE HOSPITAL WITH

CORPORATE

TO FIND THE PROBLEMS IN THE TPA & CORPORATE DEPARTMENT.

TO KNOW THE CORPORATE SOCIAL RESPONSIBILITY OF THE HOSPITAL.


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A Third Party Administrator (TPA) is an organization that processes insurance claims or

certain aspects ofemployee benefitplans for a separate entity. This can be viewed as

"outsourcing" the administration of the claims processing, since the TPA is performing a task

traditionally handled by the company providing the insurance or the company itself. Often, in the

case of insurance claims, a TPA handles the claims processing for an employerthat self-insures

its employees. Thus, the employer is acting as an insurance company and underwrites the risk.The risk of loss remains with the employer, and not with the TPA. An insurance company may

also use a TPA to manage its claims processing, provider networks, utilization review, or

membership functions. While some third-party administrators may operate as units of insurance

companies, they are often independent.

Third party administrators also handle many aspects of other employee benefit plans such as the

processing ofretirement plans and flexible. Many employee benefit plans have highly technical

aspects and difficult administration that can make using a specialized entity such as a TPA morecost effective than doing the same processing in house.

Health care

Third party administrators are prominent players in the managed care industry and have the

expertise and capability to administer all or a portion of the claims process. They are normally

contracted by a health insurer or self-insuring companies to administer services, including claims

administration, premium collection, enrollment and other administrative activities. A hospital or

provider organization desiring to set up its own health plan will often outsource certain

responsibilities to a TPA.
http://en.wikipedia.org/wiki/Insurancehttp://en.wikipedia.org/wiki/Employee_benefithttp://en.wikipedia.org/wiki/Outsourcinghttp://en.wikipedia.org/wiki/Employerhttp://en.wikipedia.org/wiki/Insurance_companyhttp://en.wikipedia.org/wiki/Underwriting#Insurancehttp://en.wikipedia.org/wiki/Financial_riskhttp://en.wikipedia.org/wiki/Utilization_reviewhttp://en.wikipedia.org/wiki/Retirement_planhttp://en.wikipedia.org/wiki/Managed_carehttp://en.wikipedia.org/wiki/Managed_carehttp://en.wikipedia.org/wiki/Retirement_planhttp://en.wikipedia.org/wiki/Utilization_reviewhttp://en.wikipedia.org/wiki/Financial_riskhttp://en.wikipedia.org/wiki/Underwriting#Insurancehttp://en.wikipedia.org/wiki/Insurance_companyhttp://en.wikipedia.org/wiki/Employerhttp://en.wikipedia.org/wiki/Outsourcinghttp://en.wikipedia.org/wiki/Employee_benefithttp://en.wikipedia.org/wiki/Insurance


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For example, an employer may choose to help finance the health care costs of its employees by

contracting with a TPA to administer many aspects of a self-funded health careplan.

Commercial general liability

This term is also now commonly used in commercial general liability (CGL) policies or so called

"casualty" business. In these instances the liability policies are written with a large (in excess of

$50,000) self insured retention (SIR) that operates somewhat like a deductible, but rather than

being paid at the end of a claim (when a loss payment is made to a claimant) the money is paid

up front by the insured for costs, expenses, attorney fees etc. as the claim moves forward. If there

is a settlement or verdict within the SIR then that is also paid by the insured up to the limit of the

SIR, before the insurer steps in and pays its portion. The TPA acts like a claims adjuster for the

insurance company and sometimes works in conjunction with the inside insurance company

claims adjuster or an outside claims investigator as well as the defense counsel. The defense

counsel in some situations is selected by the TPA. The point is that the larger the SIR the more

responsibility the TPA has over the control of the way the claim is handled and ultimately

resolved. Some self insured retentions are in the millions of dollars and the TPAs are largemultinational non-insurance entities that handle all the claims. In some cases the insured sets up

an entire department within their company (and staffs it with claim savvy people) to act as the

TPA as opposed to hiring a commercial
http://en.wikipedia.org/wiki/Self-funded_health_carehttp://en.wikipedia.org/w/index.php?title=Commercial_general_liability&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Self_insured_retention&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Self_insured_retention&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Commercial_general_liability&action=edit&redlink=1http://en.wikipedia.org/wiki/Self-funded_health_care


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Research Methodology:-STUDY AREA: NIGHTINGALEHospitals Sampli ng method:In the present study of customer satisfaction,

the samples have been drawn by Simple Random MethodSampling, from the various wards of the hospital.

Survey Instrument:Two types of data sources have been used in the study:

1. Primary data: Direct observation Questionnaire for patient

Parameter of study:

i.

Responsivenessii. Waiting timeiii. Punctualityiv. Environmentv. Behaviorvi. General

2. Secondary data: Data analysis of past records (patient feedback forms) Information through Various booklets, registers etc.


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INSURANCE

COMPANY

TPAHOSPITAL

PATIENT


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Nightingale hospital has the largest diagnostic and Medicare facilities in eastern

India with 25 years excellence. The diagnostic and OPD section is full equippedwith modern machines and experienced technician and doctors. Also its having

ISO 9001:2008 accreditation and CMC vellore Lab, which is only on e in Kolkata.

For this advantage, the patient flow in OPD is high. That is why more corporate s

is tied with the hospital and TPA is also empanelled.

Average mediclaim patient in every month

The data is showing the graphical bar chart of average mediclaim patient in every month in the

hospital. The data is prepared from study of 1000 patients.

0

500

1000

1500

2000

2500

TPA CORPORATE WBHS

OUT PATIENT

IN PATIENT


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The data is showing the patient satisfaction rate of all mediclaim patients. From 500 patients

feedback, the data has prepared. It is showing that there is high satisfaction in the corporate

patients.

0

2

4

6

8

10

12

TPA patient corporate

patient

WBHS patient CGHS patient

Patient satisfaction rate

Patient satisfaction rate


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Average cashless and reimbursement treatment

CASHLESS- 70% REIMBURSMENT- 30%

The data is showing the cashless treatment and reimbursement treatment. It is prepared from the

hospital information system. It is showing that cashless patient is more than reimbursement.

CASHLESS

REIMBURSMENT


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The administration & reception should be more able in answering thepatients query about mediclaim.

o Tie up with limited some third party administero Lack of information and communicationo Middle level marketing plans because lack of corporate patient in IPD Lack of space in TPA & corporate department.

Lack of communication between Mediclaim and reception section.


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RECOMMENDATION

Doctors should be very punctual regarding their arrival time, despite their personal problems;

they should be developed to their duties by realizing the exact meaning of their profession.

The marketing plans & strategies should develop. New packages should launch.

Individual policy med claim should start.

Proper orientation progress, campaigning advertising are to be exercise to make general people

will aware about the uniqueness at the hospital regarded at health care service.


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CONCLUSIONPatient satisfaction can be achieved by providing them quality service,

whenever they need it. Patient demands good quality care and value for the money they spent.

Hence, a quality system defines roles, responsibilities, process & procedure with in the

organization in order to ensure that staffs are able to do and carry out quality assurance activities.

Failure to provide the quality service will indicate poor patient satisfaction rate and also erosion

of the hospital image which is based on trust & confidence.

As it evident from the above study that of the grievances and problems are solved thepatients will be satisfied. A satisfied customer is the best marketing agent for any hospital. He

will promote the particular hospital to his friend and relatives. Thus the patient satisfaction is the

factor to know the reputation of the hospital.

Hence, NIGHTINGALE HOSPITAL pledged to the welfare of the people. The patients

view point is significantly important in terms of social acceptance of the service provided.

Evaluation finding based on peoples opinion and recommendation needs to be harmonized with

the present concept of hospital service.