بررسی میزان کسورات اعمال شده سازمانهای بیمه خدمات درمانی و تأمین اجتماعی نسبت به صورت حسابهای ارسالی بیمارستا نهای آموزشی شهر خرم آباد

نوع مقاله: مقاله پژوهشی


عنوان مقاله [English]

A Survey on Deduction Rate Applied By Medical Services and Social Security Insurance Organizations in Respect to Accounts Receivable of Khoram Abad Teaching Hospitals

چکیده [English]

Introduction: the main source of hospital income is by selling health care services provided to the
insured. Thus, the quality of services and facilities to the insured population and other individuals can be
improved by controlling these resources to make correct and efficient use of them and to avoid the wasting.
So the aim of research was survey the amount deduction rate by medical services and social security
insurance organizations with accounts to be sent to Teaching Hospitals University.
Methods: The study was cross-sectional, descriptive and type of it was applied study Research
documents included all bills sent by Khorramabad Teaching Hospitals to Medical Services and Social
Security organizations. The instrument for data collection was check list. Data by descriptive statistic and
SPSS software were analyzed.
Results: The Mean of hospitalization and outpatient deductions accounts sent with Medical Services
insurance was 4.22%, the highest and the lowest deductions accounts, respectively, were related to
Shohadaye Ashaeer with 5.46 % and psychiatric hospital with 0.18 %. And so, the anesthesia cost have a
highest percentage of bills deductions (18.46%). the average of hospitalization and outpatient deductions
accounts sent with Social Security insurance was 4.22%. Shohadaye Ashaeer hospital with 6.24 % of most
deduction and psychiatric hospital with 0.19 % had the lowest deduction.
Conclusion: although deduction was applied to a small percentage of accounts, a significant financial
burden was imposes to the hospitals. The major causes of deduction, documentation incomplete records,
lack of familiarity with hospital information systems, incomplete and incorrect registration insurance code;
up coding, incorrect calculations, lack of adequate training and other factors as is. It is recommended to
universities for reduce the amount of deductions to adopt appropriate policy.

کلیدواژه‌ها [English]

  • medical services insurance
  • Social Security Insurance
  • deductions
  • billing
  • Hospital