教学医院收费审计研究
Study of billing audits in a teaching hospital.
作者信息
Guerrer Gabriela Favaro Faria, Lima Antônio Fernandes Costa, Castilho Valéria
机构信息
Programa de Pós-Graduação em Gerenciamento em Enfermagem, Escola de Enfermagem, Universidade de São Paulo, São Paulo, SP, BR.
Departamento de Orientação Profissional, Escola de Enfermagem, Universidade de São Paulo, São Paulo, SP, BR.
出版信息
Rev Bras Enferm. 2015 May-Jun;68(3):358-63, 414-20. doi: 10.1590/0034-7167.2015680306i.
OBJECTIVES
to determine which component items of hospital bills, examined by nurse auditors, were adjusted the most during pre-analysis; to identify the impact upon revenue caused by the adjustments to bills analyzed by physician and nurse auditors; and to identify disallowances related to items checked by the audit team.
METHOD
quantitative, exploratory, descriptive, single-case study.
RESULTS
after analysis of 2,613 bills, it was found that the item most included by nurses was gas (90.5%) and the most excluded was inpatient drugs (41.2%). Hemodynamics materials, gases and equipment had the greatest impact on upward adjustments. Downward adjustments were the result of improper entries on bills and did not generate revenue losses. Of total disallowances, 52.24% were related to the pre-analysis of nurses and 47.76% to that of physicians.
CONCLUSION
this study of the pre-analysis process provides input that enhances knowledge about hospital bill audits.
目的
确定护士审计员检查的医院账单中的哪些组成项目在预分析期间调整最多；确定医生和护士审计员对账单的调整对收入产生的影响；以及确定与审计团队检查项目相关的不允许情况。
方法
定量、探索性、描述性单案例研究。
结果
在分析2613份账单后发现，护士最常列入的项目是气体（90.5%），最常排除的是住院药品（41.2%）。血流动力学材料、气体和设备对向上调整影响最大。向下调整是账单录入不当的结果，不会造成收入损失。在总不允许情况中，52.24%与护士的预分析有关，47.76%与医生的预分析有关。
结论
这项对预分析过程的研究提供了有助于增强对医院账单审计了解的信息。
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