Impacto financiero de las glosas por servicios de tomografía no justificadas en la IPS Odontotrans ubicada en Cali en el último trimestre del 2024
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Fecha
2025
Autores
Acosta Orellano, Ana Julieth
González Quintero, Nicolle
Hernández Pacheco, James Alberto
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Ediciones Universidad Simón Bolívar
Facultad de Administración y Negocios
Facultad de Administración y Negocios
Resumen
Las glosas médicas constituyen uno de los principales retos financieros y administrativos a
los que se enfrentan las Instituciones Prestadoras de Servicios de Salud (IPS) en Colombia.
Estas objeciones, formuladas por las Entidades Responsables de Pago (ERP) al momento de
auditar las facturas radicadas, se convierten en una fuente de retraso en el recaudo, de pérdida
de ingresos y de altos costos administrativos. Particularmente, en el área de imagenología,
las glosas asociadas a la ausencia de justificación clínica en los servicios de tomografía
representan una de las causales más frecuentes y costosas para las instituciones. La IPS,
ubicada en Cali, no es ajena a esta problemática: durante el último trimestre de 2024 presentó
un porcentaje considerable de glosas por falta de soporte clínico, lo cual afectó de manera
significativa su flujo de caja y su sostenibilidad operativa.
Este ensayo tiene como objetivo analizar el impacto financiero de estas glosas y plantear un
paquete de acciones integrales que permitan reducirlas de forma significativa. La tesis que
orienta el trabajo sostiene que la articulación de procesos clínicos y administrativos, bajo un
esquema estandarizado de control y seguimiento, es clave para prevenir glosas injustificadas
y fortalecer la liquidez institucional. Para ello, el ensayo desarrolla un marco teórico
sustentado en literatura sobre costos de no calidad, gestión financiera en salud y capital de
trabajo, y expone un estudio de caso con los datos que reproducen la dinámica de la IPS.
En el análisis se identificó que el 61% de las cuentas por tomografía presentaron glosas, de
las cuales el 45% correspondió a la falta de justificación clínica, con un monto promedio
mensual glosado superior a los 1.568 millones de pesos. Estas cifras se reflejaron en un DSO
(días de cartera) de 92 días y en un tiempo promedio de radicación (TAT) de 12 días, lo que
evidencia ineficiencias tanto en el proceso clínico como en el administrativo. Frente a este
escenario, se propuso un paquete de intervención conformado por cuatro acciones
prioritarias: (1) un checklist clínico-administrativo obligatorio antes de radicar; (2) reglas
automáticas de validación en el software de facturación; (3) auditoría concurrente con
retroalimentación al equipo clínico; y (4) un tablero de control con indicadores y metas
definidas
Medical billing objections, known in Colombia as glosas, represent one of the main financial and administrative challenges faced by Health Service Provider Institutions (IPS). These objections, formulated by Payer Entities (ERP) during the auditing of invoices, have become a source of delays in cash collection, loss of revenue, and increased administrative costs. Particularly in diagnostic imaging, glosas related to the absence of clinical justification in tomography services are among the most frequent and costly for institutions. IPS, located in Cali, is no exception: during the last quarter of 2024 it presented a considerable percentage of objections due to lack of clinical support, significantly affecting its cash flow and operational sustainability. This essay aims to analyze the financial impact of these glosas and propose a package of integrated actions to significantly reduce them. The guiding thesis states that the articulation of clinical and administrative processes, under a standardized control and monitoring scheme, is key to preventing unjustified objections and strengthening institutional liquidity. To this end, the essay develops a theoretical framework based on literature on non-quality costs, financial management in health care, and working capital, and presents a case study that reproduces the dynamics of IPS. The analysis identified that 61% of tomography accounts presented objections, of which 45% corresponded to lack of clinical justification, with an average monthly amount exceeding COP 1.568 billion. These figures were reflected in an average collection period (DSO) of 92 days and an average turnaround time (TAT) of 12 days, evidencing inefficiencies in both the clinical and administrative processes. To address this scenario, a four-pronged intervention package was proposed: (1) a mandatory clinical-administrative checklist before billing; (2) automated validation rules in the billing software; (3) concurrent auditing with feedback to the clinical team; and (4) a control dashboard with defined indicators and goals.
Medical billing objections, known in Colombia as glosas, represent one of the main financial and administrative challenges faced by Health Service Provider Institutions (IPS). These objections, formulated by Payer Entities (ERP) during the auditing of invoices, have become a source of delays in cash collection, loss of revenue, and increased administrative costs. Particularly in diagnostic imaging, glosas related to the absence of clinical justification in tomography services are among the most frequent and costly for institutions. IPS, located in Cali, is no exception: during the last quarter of 2024 it presented a considerable percentage of objections due to lack of clinical support, significantly affecting its cash flow and operational sustainability. This essay aims to analyze the financial impact of these glosas and propose a package of integrated actions to significantly reduce them. The guiding thesis states that the articulation of clinical and administrative processes, under a standardized control and monitoring scheme, is key to preventing unjustified objections and strengthening institutional liquidity. To this end, the essay develops a theoretical framework based on literature on non-quality costs, financial management in health care, and working capital, and presents a case study that reproduces the dynamics of IPS. The analysis identified that 61% of tomography accounts presented objections, of which 45% corresponded to lack of clinical justification, with an average monthly amount exceeding COP 1.568 billion. These figures were reflected in an average collection period (DSO) of 92 days and an average turnaround time (TAT) of 12 days, evidencing inefficiencies in both the clinical and administrative processes. To address this scenario, a four-pronged intervention package was proposed: (1) a mandatory clinical-administrative checklist before billing; (2) automated validation rules in the billing software; (3) concurrent auditing with feedback to the clinical team; and (4) a control dashboard with defined indicators and goals.
Descripción
Palabras clave
Glosas, Tomografía, Justificación clínica, Auditoría de cuentas médicas, Flujo de caja, IPS, Colombia
