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Showing 2 results for Insurance Deduction
Evaluation of the Analytical Dashboard of Designed Health Insurance Deductions, based on Business Intelligence
Eng. Meisam Fallahnezhad, Reza Safdari,
Volume 15, Issue 3 (8-2021)
Abstract
Background and Aim: Large amounts of hospital costs are not reimbursed annually by health insurance as deductions. Therefore, reducing deductions is very important for the hospital. In the study of design and implementation of analytical dashboard of insurance deductions based on medical intelligence business, to improve financial management with the aim of focusing on assessing the level of satisfaction and its applicability has been done.
Materials and Methods: To design the questionnaire, first 27 questions were prepared through library studies and interviews with members of the hospital board of directors, and the validity and consistency of its items were determined through content validity and Cronbach’s alpha coefficient. Data were analyzed in SPSS software and the results were used to design and implement the dashboard.
Results: The study is of development-applied type. In the first phase, to determine Content Validity Ratio CVI (Content Validity Index), and CVR (Content Validity Ratio) a researcher-made questionnaire was provided to 20 experts. In the second phase, by building a data warehouse in SQL (Structured Query Language), the information of the tables related to the deductions of the hospital HIS system was transferred to it and the operational information of the organization was extracted and converted into DW format and the map information was tested. OLAP (Online Analytical Processing) services were then loaded on the created analytics database. In the last step, Power BI tool was selected and used to create business intelligence mechanisms, display and visualize information. In the third phase, using the QUIS (Questionnaire for User Interface Satisfaction) standard questionnaire, the level of satisfaction and usability of the dashboard was evaluated by 15 experts.
Conclusion: In this study, two questionnaires were used. CVR was measured in all items of the first questionnaire, more than 0.50 and CVI was measured in the upper areas of 0.90 and Cronbach’s alpha coefficient was obtained between 0.8 and 0.9, which indicated a good level. The second questionnaire was to evaluate the level of satisfaction and usability of the dashboard that the average of the total evaluation based on the indicators of the QUIS questionnaire is equal to 85.40. Therefore, the level of satisfaction and usability of the dashboard was “very good” for the evaluators.

Assessing the Effect of the Physician's Presence on the Error of Recording Surgical Codes by Surgical Assistants and the Resulting Financial Effects in Rasoul Akram Hospital
Mohamad Hoseini Kasnavieh, Mahsa Mahmoudinejad, Mohammad Veisy, Pouya Hedayati Shahidani, Ali Tahmasebi,
Volume 16, Issue 5 (12-2022)
Abstract
Background and Aim: this study aims investigating the effect of the physician's presence on the error of recording surgical codes by surgical assistants and the resulting financial effects in Rasoul Akram hospital.
Materials and Methods: The present study was a descriptive-analytical and prospective study that was performed by collecting data in the hospital and reviewing the documents from Jun to March 2022. Therefore, in order to compare the deductions according to the presence or absence of the doctor, an expert was stationed in the operating room to enter the information in special forms, and thus the types of deductions for each of the mentioned situations were identified. T-test was used for analysis between the two groups (presence and absence of physician) and data were analyzed using Excel and SPSS software.
Results: Three hundred and one records were reviewed during the presence of the physician and 300 cases during the absence of the physician based on Cochran sampling formula. The percent difference between hidden deductions in the presence and absence of the physician was not significant (P-value=0.078). However, the difference between the obvious deductions in the presence and absence of the physicians was significant (P-value=0.024). The difference in obvious deduction costs was significant in the presence or absence of a physician (P-value<0.001). But, the difference in hidden fraction costs in the presence or absence of physicians, was not significant (P-value=0.435).
Conclusion: The presence or absence of a surgeon has an effect on the amount of errors in the registration of surgical codes by the surgeon’s assistant and, as a result, this matter affects the percentage and costs of surgical deductions, especially in the obvious deductions. Therefore, planning for the presence of the surgeon in cases where the error of registering the codes by the surgeon’s assistant leads to obvious deductions, can help to more accurate documentation and, as a result, fewer deductions are accrued.


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