Obert S J
Nursingconnections. 1990 Summer;3(2):5-10.
Many third-party payors, which include commercial health and auto insurance companies and workmen's compensation carriers, are requesting access to their clients' itemized patient statements and medical records for verifying accuracy of charges and documentation of services rendered. If even a portion of the payment is withheld until the audit is completed, slowing of cash flow results. A slow cash flow may ultimately have profound effects on the quality, or even availability, of patient care. Hospitals are finding it cost effective to have someone within their institution audit patient accounts and medical records to identify problem areas that may result in denial of payment. Nurses are being recruited to perform these audits because of their knowledge of documentation standards and patient account charging procedures. With this background, the nurse auditor is also able to assess educational needs of the nursing staff and work collaboratively with other departments to correct deficiencies.
许多第三方付款人，包括商业健康和汽车保险公司以及工人赔偿承保人，都要求获取其客户的详细患者账单和病历，以核实收费的准确性和所提供服务的记录。如果在审计完成之前哪怕只是扣留一部分款项，就会导致现金流放缓。现金流缓慢最终可能会对患者护理的质量甚至可及性产生深远影响。医院发现，在其机构内安排人员审计患者账目和病历，以识别可能导致付款被拒的问题领域，具有成本效益。由于护士了解文件记录标准和患者账目收费程序，医院正在招聘护士来进行这些审计。基于这样的背景，护士审计员还能够评估护理人员的教育需求，并与其他部门合作纠正不足之处。
