Sağlık hizmeti geri ödemesinde fatura kesinti nedenleri ve finansal kaybın incelenmesi
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Dosyalar
Tarih
2021
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Bakırçay Üniversitesi Lisansüstü Eğitim Enstitüsü
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu çalışmanın amacı; özel hastanelere başvuran SGK hastalarının fatura kesinti
nedenlerini ve tutarlarını belirlemektedir. Çalışma, Van ilinde faaliyet gösteren iki özel
hastanede yapılmıştır. Araştırma verileri; her iki hastanenin 01.01.2020 / 30.06.2020
tarihleri arasındaki altı faturalama döneminde; ayakta hastalar, yatan hastalar,
günübirlik hastalar ve diğer hastalar kategorilerden SGK’nın örnekleme yöntemiyle
seçtiği hasta faturaları oluşturmaktadır. Araştırmanın verilerinin analizinde tanımlayıcı
istatistiklerden yararlanılmıştır. Araştırmanın verileri, her hastane için toplam
düzenlenen fatura sayıları, örneklenen ve kesinti yapılan fatura sayıları ve tutarları ile
fatura kesinti nedenleri olarak analiz edilmiştir. Altı aylık dönemde fatura kesintilerinin
fatura tutarı içindeki payı A hastanesinde %1,72 ve B hastanesinde %0,12 bulunmuştur.
Her iki hastanede de fatura dönemleri arasında kesinti oran ve tutarları farklılık
göstermektedir. Tedavi gruplarına göre fatura kesinti oranı A hastanesinde en yüksek
diğer grubunda, B hastanesinde ise günübirlik grubundadır. Her iki hastanede da sayıca
en fazla sayıda fatura kesintisine, hasta dosyasında endikasyon ve muayene bilgisinin
olmaması neden olmuştur. Tutar açısından en fazla kesintiye neden olan faktör ise,
yoğun bakım tedavilerinin yanlış basamaklandırılmasıdır. Çalışma sonucunda, her iki
hastanedeki fatura kesinti oranlarının düşük olduğu (yaklaşık binde bir)
değerlendirilmiştir. Ancak bu kesintilerin de diğer birimler ile koordinasyon
geliştirilmesi ve fatura sürecinin daha iyi yürütülmesi ile engellenebilir olması
nedeniyle, hastaneler açısından geliştirmeye açık bir alan olduğunu söylemek
mümkündür
The aim of this study; It determines the reasons and amounts of bill deductions of SSI patients who apply to private hospitals. The study was conducted in two private hospitals in the province of Van. Outpatients, inpatients, outpatients, and other patients comprise the patient bills picked by SSI by sampling method in the six billing periods of both institutions between 01.01.2020 and 30.06.2020. In order to analyze the study's data, descriptive statistics were used. The data of the research were analyzed as the total number of invoices issued for each hospital, the number and amounts of invoices sampled and deducted, and the reasons for bill cuts. In the six-month period, the share of invoice deductions in the invoice amount was 1.72% in Hospital A and 0.12% in Hospital B. In both hospitals, deduction rates and amounts vary between billing periods. According to the treatment groups, the rate of bill deduction is highest in the other group in hospital A and in the outpatient group in hospital B. The absence of indication and examination information in the patient file resulted in the greatest number of bill decreases in both institutions. The factor that causes the most interruptions in terms of amount is the incorrect stratification of intensive care treatments. As a result of the study, it was determined that the bill deduction rates in both hospitals were low (approximately one in a thousand). However, it is possible to say that these cuts are a significant loss for hospitals, since they can be prevented by developing coordination with other units and carrying out the billing process better.
The aim of this study; It determines the reasons and amounts of bill deductions of SSI patients who apply to private hospitals. The study was conducted in two private hospitals in the province of Van. Outpatients, inpatients, outpatients, and other patients comprise the patient bills picked by SSI by sampling method in the six billing periods of both institutions between 01.01.2020 and 30.06.2020. In order to analyze the study's data, descriptive statistics were used. The data of the research were analyzed as the total number of invoices issued for each hospital, the number and amounts of invoices sampled and deducted, and the reasons for bill cuts. In the six-month period, the share of invoice deductions in the invoice amount was 1.72% in Hospital A and 0.12% in Hospital B. In both hospitals, deduction rates and amounts vary between billing periods. According to the treatment groups, the rate of bill deduction is highest in the other group in hospital A and in the outpatient group in hospital B. The absence of indication and examination information in the patient file resulted in the greatest number of bill decreases in both institutions. The factor that causes the most interruptions in terms of amount is the incorrect stratification of intensive care treatments. As a result of the study, it was determined that the bill deduction rates in both hospitals were low (approximately one in a thousand). However, it is possible to say that these cuts are a significant loss for hospitals, since they can be prevented by developing coordination with other units and carrying out the billing process better.
Açıklama
Anahtar Kelimeler
Billing processes, Medical accounting, Private health institutions, Reasons for bill cuts, Reimbursement methods, Fatura kesinti nedenleri, Faturalama, Geri ödeme yöntemleri, Medikal muhasebe, Özel sağlık kurumları
