Mapping the Hospital Billing Process: The Case of the a Federal Hospital in Rio de Janeiro

Souza, Ana Maria de Freitas Moura; Oliveira, Saulo Barbará de; Daher, Emílio Possidente

doi:10.1016/j.procs.2016.09.210

Cited by 3 publications

(2 citation statements)

References 2 publications

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“…In Brazil, the main databases storing health-related information are generated from SUS (de Mello Jorge et al, 2010; Paim et al, 2011; Souza et al, 2016). These databases can be classified into: (1) epidemiological (such as the Live Births Information System/SINASC; the Mortality Information System/SIM; the Information System for Notifiable Diseases/SINAN), which are used for surveillance, evaluation, and research to address public health questions; (2) administrative (such as the Outpatient Information System/SIA-SUS and the Hospital Information System/SIH-SUS), which are used for accounting and control of the production of the services provided; and (3) clinical, which are used to store clinical data on patients for future reference (Souza et al, 2016).…”

Section: Databases Used In Health Outcomes/policy Research In Brazilmentioning

confidence: 99%

Administrative Data Linkage in Brazil: Potentials for Health Technology Assessment

et al. 2019

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Health technology assessment (HTA) is the systematic evaluation of the properties and impacts of health technologies and interventions. In this article, we presented a discussion of HTA and its evolution in Brazil, as well as a description of secondary data sources available in Brazil with potential applications to generate evidence for HTA and policy decisions. Furthermore, we highlighted record linkage, ongoing record linkage initiatives in Brazil, and the main linkage tools developed and/or used in Brazilian data. Finally, we discussed the challenges and opportunities of using secondary data for research in the Brazilian context. In conclusion, we emphasized the availability of high quality data and an open, modern attitude toward the use of data for research and policy. This is supported by a rigorous but enabling legal framework that will allow the conduct of large-scale observational studies to evaluate clinical, economical, and social impacts of health technologies and social policies.

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Section: Databases Used In Health Outcomes/policy Research In Brazilmentioning

confidence: 99%

Administrative Data Linkage in Brazil: Potentials for Health Technology Assessment

et al. 2019

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“…Penelitian Souza et al di Federal Hospital Rio De Janeiro menyimpulkan bahwa bagian tagihan klaim di Rumah sakit perlu meningkatkan proses manajemen yang mampu meningkatkan kualitas informasi yang di produksi, mengidentifikasi kelemahan-kelemahan dalam proses klaim, untuk menekan proses yang berulang-ulang dalam administrasi klaim dengan standardisasi dan kontrol yang optimal 12 .…”

Section: Penyebab Pengembalian Berkas Klaimunclassified

Pengembalian Berkas Klaim Pasien Peserta Jaminan Kesehatan Nasional (Jkn) Di Rsud Sultan Syarif Mohamad Alkadrie Kota Pontianak

Andi Sulaimana,

Andreasta Meliala,

Julita Hendrartini

2022

JMPK

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Background: Approach of managed care in the National Health Insurance Program (JKN) puts hospitals as a health facility referral with the prospective payment system. Treatment of patients should be done and handled in primary health facilities. Although the number of patient referral to hospitals in JKN era remains high. The impact of the hospital is faced with an increase in claims bills to BPJS Kesehatan. By 2016 in RSUD Pontianak it was noted that 6.98% of the income came from JKN hospital patients which had not been paid by BPJS Kesehatan, so some were returned. A research needs to be conducted on the cause of the returned claim file from BPJS Kesehatan verifier to RSUD Pontianak. Objective: To find out the cause of the claims pending in RSUD Pontianak. Methods: The research is an exploratory case study with a single case study design approach. Results: The claim process at RSUD Pontianak is still not as good as never completed every month. Most of the causes of returned claims are administrative errors and medical reasons. Maladmin istration in the form of typing errors, dates, but a sign from the doctor. Medical reasons include coding disagreements, differences in perceptions about specific inspection directions, lack of support, differences in perceptions about secondary diagnostic inputs. Performance coding is limited to differences in perceptions between Coder and BPJS Kesehatan Verifier, positive physician response to file claims reversed, BPJS Kesehatan Verifier perceptions are constrained in capacity, differences in educational background, differences in understanding with Coder on Reselected Coding, and differences in regulatory implementation in the claims process. Conclusion: Technical error of claims administration process, difference of perception of coding, difference of comprehension about complementary examination, special treatment and secondary diagnosis input, and difference of perception to JKN regulation on verifier of cause of claim file of JKN patients return to RSUD Pontianak.

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A BPMN-VSM based process analysis to improve the efficiency of multidisciplinary outpatient clinics

Aissaoui

Mbarek

Layeb

et al. 2022

Production Planning & Control

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Mapping the Hospital Billing Process: The Case of the a Federal Hospital in Rio de Janeiro

Cited by 3 publications

References 2 publications

Administrative Data Linkage in Brazil: Potentials for Health Technology Assessment

Administrative Data Linkage in Brazil: Potentials for Health Technology Assessment

Pengembalian Berkas Klaim Pasien Peserta Jaminan Kesehatan Nasional (Jkn) Di Rsud Sultan Syarif Mohamad Alkadrie Kota Pontianak

A BPMN-VSM based process analysis to improve the efficiency of multidisciplinary outpatient clinics

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