Care administration addresses financial challenges

Doctors and outpatient staff work hard and put in long hours. While it’s part of the job and you won’t hear them complain, it’s good to know that everything is billed correctly after all their hard work. After all, healthcare doesn’t come for free – it needs to be paid for. Submitting accurate claims is partly in their own hands, supported by the Care Administration Department, as well as a smart tool.

Fatima Dani knows all about this, being a care registration advisor. She has been working at ZorgSaam Zeeuws-Vlaanderen since 2017 in the Care Administration Department, where a pilot was already running with Notiz – part of the digital auditing solution – to check care registrations and flag discrepancies. “We wanted to roll out that pilot in one of the outpatient clinics, with a focus on first-time-right registration in order to minimise the need for corrections afterwards.”

First time right

First-time-right registration was desperately needed, given the rising sums the hospital had to repay to insurers for invalid claims. For example, the self-assessment (Zelfonderzoek) revealed that the financial impact was particularly high for e-health consultations and parallel DBCs (care episodes opened simultaneously for the same patient). Moreover, the quality of care registration was not what it should be.

‘We found that ZorgSaam was increasingly losing control over care registration and its outcomes. Instead of first-time-right, the financial impact was increasing every year. It was time to think about how we could reduce that impact.’

Everyone on board

Fatima Dani | Care Registration Advisor

The hospital decided first and foremost to improve care registration at the source; in other words, from the very first point of entry. In the outpatient clinics, this was done in collaboration with the Care Administration Department. ‘The goal is to create a smooth workflow together – from signalling and analysing issues to giving feedback – and to stop making corrections afterwards. That’s what we’re aiming for: registration done right from the start.’

Fatima approached Dr Lodewick and her secretaries to ask if they would take part in a pilot, as the first outpatient clinic in the hospital to do so. ‘Why this clinic? Because Dermatology and Care Administration have a very good working relationship. There’s an open line of communication between us, and this clinic is always proactive and keen to take initiative. Ultimately, a pilot like this depends on everyone’s cooperation. Because without that, you have nothing.’

The financial impact on e-health consultations and parallel DBCs in particular proved to be quite large.

– Fatima Dani | Care Registration Advisor

Care delivered, but not reimbursed

Dr Lodewick seized the opportunity with both hands. ‘I’m naturally a bit of a perfectionist; I like to do things right from the start. At the end of the day though, it also comes down to money: on one hand, we want to minimise repayments to insurers, and on the other, there’s money that might be left unclaimed due to under-registration – often because of the pace of outpatient consultations. It’s work we actually do that takes time, money, staff and resources, so it’s a real shame when that isn’t reimbursed simply because we aren’t recording what we’ve actually done.’

Over the years, some of this administrative work has shifted back to the doctors. ‘I’ve worked here for almost nine years now’, says Dr Lodewick. ‘When I first started, the secretariat submitted the claims. With patients who had multiple DBCs, a procedure could easily end up linked to the wrong treatment trajectory, even though I knew exactly how it should have been recorded. For that reason, I started doing it myself. And over time, more and more of that responsibility ended up on my desk. While my colleagues and I started recording more ourselves, our secretaries took on more verification tasks. So their workload shifted too, but it certainly didn’t get any lighter!’

More knowledge at the source

For Dr Lodewick, the biggest change since the pilot has been the structured feedback on corrections. ‘Previously, the Care Administration Department would make the corrections, and if your outpatient clinic wasn’t informed, you’d simply make the same mistake next time. Today, those corrections are fed back in a structured way, grouped by category or situation. Everything is much more systematic now, whereas before it was a bit ad hoc and case by case.’

‘The idea of Dermatology serving as an example for other departments has really worked,” explains Fatima. ‘From the Care Administration Department, we can assign Notiz checks to different departments, and each one now has an average of two checks. For each department, we looked at what would be useful – also based on the self-assessment – and offered those checks. In doing so, we’re strengthening knowledge at the source, bringing teams closer together in understanding and helping each other stay sharp.’

If new issues come up in the meantime, we can address them quickly.

– Dr Lodewick | Dermatology

On the right track

Dr. Lodewick | Dermatology

To conclude, Fatima notes that ZorgSaam, with support from Performation (which has been part of Enovation since February 2025), is well on its way to optimising first-time-right registration. ‘We’re not there yet,’ she admits, ‘but we are seeing real improvement thanks to that collaboration. Because that’s what it’s really about: teamwork involving everyone who plays a part in registration.’

‘I can only agree’, adds Dr Lodewick. ‘In my experience contact with the Care Administration Department has always been very pleasant. It’s a topic that’s always interested me – even long before this project – as we’ve had regular meetings for years to discuss any recurring issues. And if new issues come up in the meantime, we can address them quickly. That’s what I value most about this collaboration.’

‘For us it’s the same’, concludes Fatima. ‘It keeps the collaborative flow going. We already had a meeting with Dermatology every other month, and now I have quarterly meetings scheduled with every department I support. It’s a great way to work!’

Want to learn more about Auditing?

We support healthcare organisations with their auditing issues and processes, just as we did for ZorgSaam Zeeuws-Vlaanderen. Please contact us! We would be delighted to provide you with further information.