Effective Factors in Insurance Deductions in One of the Armed Forces Hospitals in Tehran/ Iran: a case study

Background & Objectives: Deductions applied by insurance companies on sent bills affect the income of hospitals. If hospitals do not pay attention to this issue, it is probable that they do not receive the costs that they have paid even for the provided services. Methods: In this retrospective descriptive study conducted in one of the armed forces hospitals in Tehran in 2015, 6717 medical files belonged to the admitted cases were investigated. The list of reported deductions for admitted cases was prepared using a self-made form that included deduction topics (surgery, anesthesia, services, imaging, laboratory, supplies and equipment, beds, visit and counseling). Results: The highest rate of deduction was due to the additional request for surgery and anesthesia (30% of total deduction). The highest rates of return were respectively related to request lower than tariff rate (78%) and absence of recording services related to surgical activities (17%) and operating room and anesthesia (5%). After identifying these cases, a total of 3270 million Rial was returned to the financial resources of hospital. Conclusion: Some strategies for reducing deductions are transferring affairs related to the registration and identification of outpatient services to the authorities of the units, establishing a system for collecting the experience of personnel and transferring them to the insurance organizations, creating a system for receiving the suggestions and ideas of employees, establishing interactions with the authorities of the contracting insurance companies, having physicians to record correct codes of surgery and services as well as establishing deduction committees. Key¬words: Deduction, Insurance, Armed Forces, Hospital Citation: Vali-pour N, Mosavi-nejad SM, Meshkani Z. Effective Factors in Insurance Deductions in One of the Armed Forces Hospitals in Tehran/ Iran: a case study. Journal of Health Based Research 2017; 3(2): 141-150

Effective Factors in Insurance Deductions in One of the Armed Forces Hospitals in Tehran/ Iran: a case study

Background & Objectives: Deductions applied by insurance companies on sent bills affect the income of hospitals. If hospitals do not pay attention to this issue, it is probable that they do not receive the costs that they have paid even for the provided services. Methods: In this retrospective descriptive study conducted in one of the armed forces hospitals in Tehran in 2015, 6717 medical files belonged to the admitted cases were investigated. The list of reported deductions for admitted cases was prepared using a selfmade form that included deduction topics (surgery, anesthesia, services, imaging, laboratory, supplies and equipment, beds, visit and counseling). Results: The highest rate of deduction was due to the additional request for surgery and anesthesia (30% of total deduction). The highest rates of return were respectively related to request lower than tariff rate (78%) and absence of recording services related to surgical activities (17%) and operating room and anesthesia (5%). After identifying these cases, a total of 3270 million Rial was returned to the financial resources of hospital. Conclusion: Some strategies for reducing deductions are transferring affairs related to the registration and identification of outpatient services to the authorities of the units, establishing a system for collecting the experience of personnel and transferring them to the insurance organizations, creating a system for receiving the suggestions and ideas of employees, establishing interactions with the authorities of the contracting insurance companies, having physicians to record correct codes of surgery and services as well as establishing deduction committees. Keywords: Deduction, Insurance, Armed Forces, Hospital Citation: Vali-pour N, Mosavi-nejad SM, Meshkani Z. Effective Factors in Insurance Deductions in One of the Armed Forces Hospitals in Tehran/ Iran: a case study. Journal of Health Based Research 2017; 3(2): 141-150