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Surgical procedure billing settlement in colombia: a comparative methodological analysis of the leading health system fee schedules
Objective. To systematize the settlement methodology for surgical procedures in Colombia through a comparative review of the EPS-ISS 2001 Fee Manual and the SOAT Tariff Regime Manual, identifying the main criteria involved in the economic valuation of these services and their application in billing and medical accounts auditing processes. Methodology. A documentary and comparative review was conducted of regulatory, technical, and academic sources related to the settlement of surgical procedures, considering the criteria of identification and classification, procedure characteristics, valuation units and mechanisms, recognizable components, and the multiplicity and bilaterality rules established in the fee schedules studied. Results. Differences were identified between the structures and valuation logics of the ISS 2001 and SOAT references, particularly in their valuation mechanisms and in the rules applicable to the different components of surgical settlement. Likewise, it was established that aspects such as the access route, the operative region, bilaterality, and the performance of multiple procedures can modify economic recognition. The discussion shows that these differences go beyond fee calculation and become relevant in contracting, billing, and auditing, where clarity regarding the applicable reference, its updates, and the agreed conditions is essential to technically support the billed value and to manage differences that may lead to claim denials, reprocessing, and impacts on accounts receivable recovery. Conclusion. The settlement of surgical procedures constitutes a competency that integrates clinical, regulatory, contractual, and financial knowledge. Its correct application requires an auditor capable of interpreting fee rules and relating them to the service actually provided, the contractual conditions, and the supporting documentation of the medical account, thereby contributing to the control of discrepancies, account management, and the timely handling of resources derived from health services
