The influence of records on medical charts as a factor associated with technical disallowances
Objective: identify the influence of records in medical charts as one of the factors associated with technical disallowances. Method: quantitative, analytical, cross sectional field study conducted in 2018 in two hospitals. A total of 324 payment statements were analyzed, considering five health pla...
| Autores: | , , , , , |
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| Tipo de recurso: | artículo |
| Estado: | Versión publicada |
| Fecha de publicación: | 2022 |
| País: | Brasil |
| Institución: | Universidade Federal de Minas Gerais (UFMG) |
| Repositorio: | Reme (Online) |
| Idioma: | portugués inglés |
| OAI Identifier: | oai:periodicos.ufmg.br:article/39425 |
| Acceso en línea: | https://periodicos.ufmg.br/index.php/reme/article/view/39425 |
| Access Level: | acceso abierto |
| Palabra clave: | Registros Eletrônicos de Saúde Faturamento Saúde Suplementar Gestão em Saúde Electronic Health Records Billing Supplemental Health Health Management Registros Electrónicos de Salud Facturación Salud Complementaria Manejo de la salud |
| Sumario: | Objective: identify the influence of records in medical charts as one of the factors associated with technical disallowances. Method: quantitative, analytical, cross sectional field study conducted in 2018 in two hospitals. A total of 324 payment statements were analyzed, considering five health plan operators in each hospital. These statements contain the codes of disallowances provided in the TISS [Exchange of Information on Supplementary Health] Table. Results: technical disallowances concerning materials were higher than those concerning medications in hospitals 1 and 2, 90.99% and 84.79%, respectively. The factors associated with technical disallowances were hospital stay — p=0.001 in hospital 1 and p=0.01 in hospital 2 — and type of hospitalization in hospital 2, p=0.000. Hospital 1 amounted to R$2,305.61 (2.28%) of disallowances in nine medical charts. However, all the medical charts contained the records of technical reports, which can be appealed. A different result was found for hospital 2, where 43 medical charts totaled R$31,181.14 (17.82%) of disallowances, R$3,096.13 of which concern missing codes (material and medication); hence, no appeal is possible, resulting in financial loss. Conclusion: the monetary amounts of technical disallowances were higher in both hospitals. There is evidence that the length of hospital stay generates disallowances. Therefore, the records in medical charts influence disallowances, and missing records lead to financial loss. TISS standardizes the reasons for disallowances, favoring justifications to appeal, and facilitates the analysis of records and controls of payments to the services provided. |
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