Volume 20, Issue 4 (July - August 2021)
Payesh 2021, 20(4): 415-425 |
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Ethics code: IR.KUMS.REC.1397.961
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Makhsosi B R, Amiri H, Evani N, rahmani S, Kazazi S. Evaluation of the causes of prescription deductibles in a teaching hospital in Kermanshah. Payesh 2021; 20 (4) :415-425
URL: http://payeshjournal.ir/article-1-1517-en.html
URL: http://payeshjournal.ir/article-1-1517-en.html
1- Asadabad School of Medical Sciences, Asadabad, Iran
2- Clinical Research Development Center, Imam Khomeini Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
2- Clinical Research Development Center, Imam Khomeini Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
Abstract: (1543 Views)
Objectives: Due to the fact that most of insurance companies have deductions and long delays in the reimbursement of bills. They are causing dissatisfaction in the hospitals of the contracting party. Therefore, the present study was conducted with the aim of determining the causes of prescription deductibles in a teaching hospital in Kermanshah, Iran in 2018.
Methods: In this cross-sectional and descriptive-analytical study, all 560 cases related to 2018 year that were covered by the insurance of the hospital were examined. Data were analyzed using the SPSS software version 23. The significant level was set at 5 percent.
Results: The results of the present study showed that the mean and standard deviation of prescription deductibles in the hospital during 2019 were 16596782.90 and 335966366.43 Rails, respectively. The highest amount of prescription deductibles was recorded in January and the lowest was recorded in March. The highest cause of prescription deductibles in the opinion of the participants with a frequency of 44.4% was related to the lack of accurate and precise registration of drugs and equipment in the doctor's and nursing notes.
Conclusion: The findings suggest review of medication application forms by at least two people, reminding and educating doctors, inspection by insurance and income personnel regularly, encouraging staff if deductions are reduced, reducing the time interval between shifts of physicians and nurses, increasing cooperation between insurance companies and income personnel with the pharmacy department, and using specialists to update the price of medicines before entering the pharmacy might help to lessen prescription deductibles
Methods: In this cross-sectional and descriptive-analytical study, all 560 cases related to 2018 year that were covered by the insurance of the hospital were examined. Data were analyzed using the SPSS software version 23. The significant level was set at 5 percent.
Results: The results of the present study showed that the mean and standard deviation of prescription deductibles in the hospital during 2019 were 16596782.90 and 335966366.43 Rails, respectively. The highest amount of prescription deductibles was recorded in January and the lowest was recorded in March. The highest cause of prescription deductibles in the opinion of the participants with a frequency of 44.4% was related to the lack of accurate and precise registration of drugs and equipment in the doctor's and nursing notes.
Conclusion: The findings suggest review of medication application forms by at least two people, reminding and educating doctors, inspection by insurance and income personnel regularly, encouraging staff if deductions are reduced, reducing the time interval between shifts of physicians and nurses, increasing cooperation between insurance companies and income personnel with the pharmacy department, and using specialists to update the price of medicines before entering the pharmacy might help to lessen prescription deductibles
type of study: Descriptive |
Subject:
Helath Services Management
Received: 2020/11/1 | Accepted: 2021/08/7 | ePublished ahead of print: 2021/08/15 | Published: 2021/09/5
Received: 2020/11/1 | Accepted: 2021/08/7 | ePublished ahead of print: 2021/08/15 | Published: 2021/09/5
References
1. Kieny MP, Bekedam H, Dovlo D, Fitzgerald J, Habicht J, Harrison G, Kluge H, Lin V, Menabde N, Mirza Z, Siddiqi S. Strengthening health systems for universal health coverage and sustainable development. Bulletin of the World Health Organization 2017;95:537-539 [DOI:10.2471/BLT.16.187476]
2. Simon R, Morarji A, Ganesamurthy K. Disaster Management-Hospital perspective. International Journal of Research and Analytical Reviews 2021;8:390-394
3. Khorrmmi F, Hosseini Eshpala R, Baniasadi T, Azarmehr N, Mohammadyi F. Prioritizing insurance deductions factors of Shahid Mohammadi hospital inpatients records using Shannon Entropy. Hormozgan Medical Journal 2013; 17: 77-82 [Persian]
4. Goense L, Van Dijk WA, Govaert JA, van Rossum PS, Ruurda JP, van Hillegersberg R. Hospital costs of complications after esophagectomy for cancer. European Journal of Surgical Oncology (EJSO) 2017;43:696-702 [DOI:10.1016/j.ejso.2016.11.013]
5. Edemekong P, Annamaraju P, Haydel M. Health Insurance Portability and Accountability Act. Treasure Island (FL). 1st Edition, StatPearls Publishing: Island, 2021
6. Mohtasham Amiri Z, Rahimi Kalamroudi H, Davoudi A. Unit Analysis of Health Care Centers in Urban and Rural Area of Guilan. Journal of Guilan University of Medical Sciences 2008; 17: 24-32 [Persian]
7. Wolff J, Heister T, Normann C, Kaier K. Hospital costs associated with psychiatric comorbidities: A retrospective study. BMC health services research 2018;18:1-7 [DOI:10.1186/s12913-018-2892-5]
8. Fechtel RB, Fullenkamp C. Life Insurance Policy Disclosure for the 21st Century. Journal of Financial Service Professionals 2021;75:36-58
9. Mohamaadi E, Oliaeemanesh A, Zanganeh M, Nadarkhani F, Ghanati E, Yousefinezhadi T, Tabatabaei SM. Investigating the Rate and Causes of Hospital Deductions and Determining its Reduction Strategies in Iranian Hospitals. The Iranian Journal of Health Insurance 2020;3:92-103 [Persian]
10. Mosadegh rad AM, Esfahani P, & Nikafshar M. Hospitals' Efficiency in Iran: A systematic review and meta-analysis of two decades of research. Payavard 2017; 11: 318-331 [Persian]
11. Nasiri rad N, Rashidian A, Joudaki H, Haghighi FA, Arab M. Assessing issues and problems in relatioship between basic insurance organizations and university hospitals: A qualitative research. Hospital 2010; 9: 8-18 [Persian]
12. Mohammadi A, Azizi AA, Cheraghbaigi R, Mohammadi R, Zarei J & Valinejadi A. Analyzing the deductions applied by the medical services and social security organization insurance toward receivable bills by university hospitals of Khorramabad. HealthInformation Management 2012; 10: 172-180
13. Afshari M, Mosadeghrad A, Arab M. The impact of quality management on reducing bill deductions at operating theatre department of Valiasr hospital a participatory action research. Journal of Hospital 2017;16:93-101 [Persian]
14. Mosadeghrad A, Afshari M, Nasrolahi R, Daneshgar S, Corani Bahador R. The Impact of Health Transformation Plan on Deductions Imposed on Imam Khomeini Hospital Complex's Bills. Journal of Hospital 2018; 17:71-79 [Persian]
15. Safdari R, Karami M, Moeini M. Causes of deductions applied by social security insurance in Kashan University of Medical Sciences hospitals. Journal of Health Information Management 2012 ; 9: 140-144 [Persian]
16. Safdari R, Sharifian R, Ghazi Saeedi M, Masoori N, Azad Manjir Z. The amount and causes deductions of bills in Tehran University of Medical Sciences Hospitals. Journal of Payavard Salamat 2011; 5: 61-70 [Persian]
17. Rostami Z, Nasiripour AA. Comparison of the Deductions of Insurance Bills in an Education-Treatment Center in Iran before and after Health Care Reform. Health Information Management 2019; 15: 281-287 [Persian]
18. Imani A, Doshmangir L. The Analysis of the Causes of Hospitalized Patients' Medical Records Deductions. Depiction of Health 2020;11:172-189[Persian]
19. Yaqubi M, Javadi M, Jndqyan M, Rjalyan F, Farahabadi ME, Mofid M, Nazari M. Investigating the amount of deductions applied by the Social Security Organization to surgeries in selected teaching hospitals in Isfahan in the first half of 2008. Journal Hospital 2009; 8:33-38 [Persian]
20. Zarei E, Najafi M, Arabi S. Investigating Level and Reasons of Insurance Deductions of Hospitalization Bills in AL Zahra Academic and Medical Center of Isfahan in 2017 Evidence Based Health Policy. Management & Economics 2020; 4: 32-39 [Persian]
21. Khalesi N, Gohari M, Vatankhah S, Abbasimani Z. The Effect of Employee Training on Insurance Deduction Rate at Firoozgar Teaching Hospital 2008-2009. Journal of Health Administration 2011; 13: 19-26 [Persian]
22. Safdari R, Ghazi Saeedi M, Sheykhotayefe M, Jebraeily M, Farajolah SS, Maserat E, et al. The Study of Insurance Deductions from Point of Insurance Professionals in Educational Hospitals of Mashhad University of Medical Sciences. Journal of Payavard Salamat 2017; 11: 10-19 [Persian]
23. Askari R, Dehghan HR, Bahrami MA, Keshmiri F. Investigating the amount and causes of deductions in the bills of hospitalized patients Under the cover of social security insurance in educational hospitals Yazd University of Medical Sciences in the first half of 2008. Journal of Hospital 2009; 9: 24-28 [Persian]
24. Norooz Sarvestani E, Pour Mohammadi K, Kavoosi Z, Yousefi A. The amount and causes insurance deductions of Shohada-e Sarvestan hospital and ways to reduce it by using the techniques of problem-solving 2012. Journal Manage Med Inform Sci 2015; 2: 122-132 [Persian]
25. Bagheri H, Amiri M. Study of the causes of insurance organizations deductions from the therapy patients documents in one hospital in Iran. Healthcare Management 2013; 4: 17-24 [Persian]
26. Peabody JW, Luck J, Jain S, Bertenthal D, Glassman P. Assessing the accuracy of administrative date in health information system. Medicine care 2004; 42: 72-1066 [DOI:10.1097/00005650-200411000-00005]
27. Tabrizi J, Alidoost S, Mardi A, Farshi-khorsand M, Rahmat M. Assessing the causes of dedicated revenues' fractions in health care centers and strategies to reduce them (A qualitative study). Journal of Hospital 2016; 15: 53-62 [Persian]
28. Krushat WM, Bhatia AJ. Estimating payment error for Medicare acute care inpatient services. Health Care Financ Review 2005; 26: 39-49
29. Howard WR. Respiratory care billing using a personal digital assistant. Respiratory Care 2004; 49: 1339-48
30. Helmons P, Grouls RJ, Roos A, Bindels A, Wessels-Basten S, Ackerman E, et al. Using a clinical decision support system to determine the quality of antimicrobial dosing in intensive care patients with renal insufficiency. Quality and Safety in Health Care 2010; 19: 6-22 [DOI:10.1136/qshc.2007.025700]
31. Mokhtari S, Eskandari S & Ayazi Z. Operators' performance evaluation on the hospital information system about the deductions of educational and medical Hajar hospital in 2012. Journal of Shahrekord University of Medical Sciences 2014; 15: 86-91 [Persian]
32. Wager KA, Lee FW, Glaser JP. Managing Health Care Information Systems: A Practical Approach for Health Care Executives. 1st Edition, John Wiley & Sons: New Jersey, 2005
33. Abdelhak M, Grostick S, Hanken MA. Health information: Management of a Strategic Resource. 4th Edition, Elsevier - Health Sciences: Philadelphia, 2014
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