Showing 4 results for Deductions
N Nasiriad, A Rashidian, H Joodaki , F Akbari Haghighi, M Arab,
Volume 9, Issue 1 (9-2010)
Abstract
Objective: the aim of this study was to determine the types of relationships and problems between basic insurance organizations and university hospitals.
Methods: this is a qualitative study conducted in 2010. We interviewed revenue officials of hospital and resident representatives of insurance organizations in nine hospitals affiliated to the Tehran University of Medical Sciences using semi-structured interview techniques. Interviews focused on relationships, problems and solutions between basic insurers and hospitals. We used the framework method for the analysis of qualitative data.
Findings: six themes were identified: relationship between insurers and hospitals, supervision tasks of insurers in hospital, causes of deductions, deduction solutions, hospital problems with insurer organizations, and insurers' representatives problems with hospitals. Conclusions: Hospitals and basic insurer should establish effective communications. The results of such relationships, in addition to solve their own problems, helps the patients. Inappropriate relationship between hospital and basic insurer organizations mostly affects the patients.
Mahnaz Afshari , Dr. Alimohammad Mosadeghrad , Dr. Mohammad Arab ,
Volume 16, Issue 1 (4-2017)
Abstract
Background: The health system of Iran is suffering from resources shortage. The health insurance companies (payers) do not confirm all hospitals’ claims (bills) and as a result do not reimburse them completely. Decreasing the amount of these deductions helps healthcare managers to use their resources efficiently. This study aimed to examine the impact of a quality management model on reducing the amount of healthcare insurance deductions at operating theatre department of Valiasr hospital in 2014-2015.
Materials and Methods: A participatory action research was used for the intervention. A quality improvement team was established and using the ten-step quality management model improved operational processes at operating theatre department. Related data were collected before and after the intervention to determine the effect of quality management system on deductions.
Results: The average deduction per patient at the beginning of the study was 339572 Rials. Illegible and uncompleted patient’s medical records, using wrong codes of surgery and anesthetics in documents and miscalculation were the main reasons of deductions. The reasons for deductions were identified and appropriate solutions were applied to decrease the amount of deductions at operating theatre department. The average deduction per patient at the end of study was 262818 Rials. The amount of deductions has decreased from 6.9 % to 3.8 %. The quality management system helped reduce the amount of deductions by 44.9%.
Conclusion: Implementing an appropriate quality management model appropriately helps reduce deductions in hospitals effectively
Dr Alimohammad Mosadeghrad, Mahnaz Afshari, Rahman Nasrolahi, Sareh Daneshgar, Rasoul Corani Bahador ,
Volume 17, Issue 2 (9-2018)
Abstract
Background: Insurance companies sometimes do not reimburse hospitals completely. Reducing the amount of deduction of bills increases hospital’s income and efficiency. This study compares the deductions imposed by social insurance organization on Imam Khomeini hospital’s bills before and after the implementation of health transformation plan.
Material and Methods: Data of this descriptive-descriptive study calculated from the deductions applied to the hospital of outpatient and inpatient bills of social insurance organization in second six months of 2013 (before implementation of health transformation plan) and the same time of 2014 (after implementation of of health transformation plan). This quasi experimental study was conducted using the data. Data was analyzed by SPSS software using paired t test.
Results: The bill deductions in the second six months of 2013 compare to the same time in 2014 were 2.9 and 11.1 percent, respectively. Hospital bill deductions increased 282.8 percent after the health transformation plan implementation. The deductions on inpatients and outpatients records increased 6 and 12 times, respectively. Most deduction was imposed on surgical and laboratory bills in 2013 and on radiotherapy, chemotherapy and hoteling bills in 2014.
Conclusion: Deductions of hospital bills extremely increased from social insurance organization after implementation of health transformation plan. In order to identify deductions causes, providing related education to staff and physicians and relative process improvement are necessary.
Saeide Alidoost, Dr Aziz Rezapour, Rahim Sohrabi, Roghayeh Mohammadibakhsh, Dr Ali Sarabi-Asiabar, Narges Rafiei,
Volume 18, Issue 1 (5-2019)
Abstract
Background: The hospitals' reliance on insurer organizations' resources is increasing due to the growing number of insured persons. However, a relatively large share of these revenues cannot be collected for various reasons and is considered as hospital deductions from revenue. Hence, this study aimed to investigate the causes of hospital deductions from revenue and strategies to reduce them in hospitals affiliated to Iran University of Medical Sciences.
Materials and Methods: This qualitative study was conducted based on the phenomenological approach in 2017. Data was collected through semi-structured interviews consisting 17 finance experts in hospitals. Data analysis was performed using MAXQDA version10 and analytical framework of Gale et al. (2013).
Results: Based on the framework analysis, two themes were identified as the underlying causes of hospital revenue deduction including direct causes and root causes of revenue deduction. Also, in order to reduce revenue deduction strategies, eight themes were recognized including interaction with insurance organizations; analysis, assessment, and feedback on revenue deficit; coordination and empowerment of employees; proper organization of human resources; strengthening regulatory system, motivational strategies; good planning and creating an organizational structure.
Conclusion: The revenue deductions occur in all stages of converting services into income and the most important factor is lack of staff awareness and incentive to control deductions. Contributions of all process owners in the hospital and insurers and in particular the commitment of hospital’s senior managers are necessary to control the deductions.
