Analyzing the Deductions Applied by the Medical Services and Social Security Organization Insurance toward Receivable Bills by University Hospitals of Khorramabad, Iran

Document Type : Original Article

Authors
Ali Mohammadi 1
Amir Abbas Azizi 2
Ramin Cheraghbaigi 3
Rouhollah Mohammadi 4
Javad Zarei 5
Ali Valinejadi 6
1 PhD Student, Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
2 PhD Student, Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad AND Instructor, Management and Health Information Technology, School of Paramedicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
3 Medical Records, Kermanshah Social Security Organization, Kermanshah, Iran
4 Nursing, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
5 PhD Student, Health Information Management, Tehran University of Medical Sciences AND Health Information Technology, School of Paramedicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
6 PhD Student, Health Information Management, Health Management and Economic Research Center, Iran University of Medical Sciences, Tehran, Iran
Abstract
Introduction: The main source of hospital income is through 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 sources to make correct and efficient use of them and to avoid wasting. Therefore, the aim of the preset study was to analyze the deduction rate by medical services and social security insurance organizations with accounts and bills sent to university hospitals. Methods: This was a cross-sectional, descriptive applied study. The study documents included all bills sent by university hospitals of Khorramabad, Iran to medical services and social security organizations. The tool for data collection was a check list. Results: The mean deductions of hospitalization and outpatient accounts sent by medical services insurance was 4.22%, and the highest and lowest deductions accounts were related to Shohadaye Ashayer with 5.46 % and psychiatric hospital with 0.18%, respectively. Besides, the anesthesia cost had the highest percentage of bills deductions (18.46%). The mean of hospitalization and outpatient deduction’s accounts sent with social security insurance was 4.22%. Shohadaye Ashayer Hospital with 6.24 % had the highest 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 imposed to the hospitals. The major causes of deduction included incomplete documentation 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. Universities are recommended to reduce the amount of deductions to adopt appropriate policy. Keywords: Insurance; Social Security; Health Services; Hospitals
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