Analysis of the Impact of Billing, Authorizations and Unknown Debts on the Technical Reserve of Health Promotion Companies: Case of HPC in Colombia

Abstract

The management of the technical reserve in Empresas Promotoras de Salud (EPS) in Colombia demonstrates adequate financial capacity to ensure the effective delivery of healthcare services. Nevertheless, the reserve's inherent nature and the unpredictability it engenders in planning engender financial risks that impair the long-term viability of such companies. The study aims to examine how filed invoices, unsubmitted authorizations, and estimated unknown debts affect the technical reserve of EPSs in Colombia from 2016 to 2021 using statistical methods like Online Linguistic Support, Autoregressive Moving Average, Autoregressive Conditional Heteroscedasticity, and Vector Autoregression. A descriptive and correlational study was conducted, considering current regulatory policies and the health insurance industry. Time series data were analyzed and revealed an inverse correlation between the explanatory and response variables. The method permits the assessment of two variables that impact technical reserve management: an increase in filed invoices and undetected claims results in decreased reserves, and filed authorizations have the opposite effect. Technical term abbreviations are explained upon their initial use in the text. Citations follow a consistent footnote style and formatting features. Similarly, we forecasted the impulse response function for the effect of technical reserves and suggested developing a predictive methodology to manage, regulate, or eradicate financial management vulnerabilities linked to HPC in Colombia. We emphasize the significance of precise authorizations for medical services since undiscovered debts may lead to financial losses for health care providers. A systematic approach is necessary to adhere to applicable regulations, including Law 100 of 1993 and associated resolutions and decrees. Healthcare providers can enhance their financial performance by ensuring accurate authorization and billing practices, thereby avoiding financial penalties.