The influence of records on medical charts as a factor associated with technical disallowances
| Autor(a) principal: | |
|---|---|
| Data de Publicação: | 2022 |
| Outros Autores: | , , , , |
| Tipo de documento: | Artigo |
| Idioma: | por eng |
| Título da fonte: | Reme (Online) |
| DOI: | 10.35699/2316-9389.2022.39425 |
| Texto Completo: | https://periodicos.ufmg.br/index.php/reme/article/view/39425 |
Resumo: | 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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The influence of records on medical charts as a factor associated with technical disallowancesLa influencia de los registros en la historia clínica como uno de los factores que se asocia al fallo técnico hospitalarioA influência dos registros do prontuário como um dos fatores associados à glosa técnica hospitalarRegistros Eletrônicos de SaúdeFaturamentoSaúde SuplementarGestão em SaúdeElectronic Health RecordsBillingSupplemental HealthHealth ManagementRegistros Electrónicos de SaludFacturaciónSalud ComplementariaManejo de la saludObjective: 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$3,096.13 of which concern missing codes (material and medication); hence, no appeal is possible, resulting in financial loss. Conclusion: the monetary amounts of technical disallowances were higher in both hospitals. There is evidence that the length of hospital stay generates disallowances. Therefore, the records in medical charts influence disallowances, and missing records lead to financial loss. TISS standardizes the reasons for disallowances, favoring justifications to appeal, and facilitates the analysis of records and controls of payments to the services provided.Objetivo: identificar la influencia de los registros en las historias clínicas como uno de los factores asociados al fallo técnico. Método: estudio cuantitativo analítico, de campo, transversal, en el año 2018, en dos hospitales. Se analizaron 324 extractos de pago, con cinco operadores de cada hospital. En estas declaraciones se describen los códigos del fallo que hacen referencia a la Tabla de Dominio de Intercambio de Información Sanitaria Suplementaria (TISS). Resultados: en los hospitales 1 y 2, el fallo técnico del material fue superior a la de la medicación, siendo del 90,99% y del 84,79%, respectivamente. Los factores asociados al fallo técnico fueron la duración de la estancia; p = 0,001 en el hospital 1 y p = 0,01 en el hospital 2, y el tipo de ingreso en el hospital 2 con p = 0,000. El Hospital 1 presentó R$ 2.305,61 (2,28%) de fallos en nueve historias clínicas. Sin embargo, todos presentaron registros de informe técnico, las cuales pueden ser apeladas. Resultados diferentes en el hospital 2, donde se han encontrado 43 historias clínicas, por un valor de R$ 31.181,14 (17,82%) y, de este valor, R$ 3.096,13 se refieren a los códigos de material y de medicamentos, no teniendo registros en las historias clínicas y no siendo posible apelar, acarreando pérdidas. Conclusión: en los dos hospitales, el valor del fallo técnico del material fue mayor. Hay pruebas de que el tiempo de permanencia puede generar fallos, y en cuanto al registro en la historia clínica, este influye en el fallo y, cuando falta, genera una pérdida financiera. El uso del TISS normaliza los motivos de los fallos, favorece la realización de la justificación del recurso, facilita el análisis de los expedientes y ayuda a controlar el pago del servicio prestado.Objetivo: identificar a influência dos registros no prontuário como um dos fatores associados à glosa técnica. Método: estudo quantitativo analítico, de campo, transversal, no ano de 2018, em dois hospitais. Analisados 324 demonstrativos de pagamento, sendo cinco operadoras de cada hospital. Nestes demonstrativos, estão descritos códigos de glosa referentes à Tabela de Domínio de Troca de Informações de Saúde Suplementar (TISS). Resultados: nos hospitais 1 e 2, a glosa técnica de material foi maior que a de medicamento, sendo 90,99% e 84,79%, respectivamente. Os fatores associados à glosa técnica foram o tempo de permanência; p= 0,001 no hospital 1 e p= 0,01 no 2 e tipo de internação no hospital 2 com p= 0,000. O hospital 1, apresentou R$ 2.305,61 (2,28%) de glosa em nove prontuários. Contudo, todos apresentaram registros de relatório técnico, que pode ser recursado. Resultado diferente do hospital 2, onde foram glosados 43 prontuários, no valor de R$ 31.181,14 (17,82%) e, desse valor, R$ 3.096,13 são referentes aos códigos de material e de medicamentos, não tendo registros em prontuários e não sendo possível fazer recurso, acarretando perda. Conclusão: nos dois hospitais, o valor da glosa técnica de material foi maior. Há evidência de que o tempo de permanência pode gerar glosa, e quanto ao registro no prontuário, este influencia na glosa e, quando ausente, gera perda financeira. A utilização do TISS padroniza os motivos de glosas, favorece a realização da justificativa do recurso, facilita a análise dos registros e auxilia no controle do pagamento do serviço prestado.Universidade Federal de Minas Gerais2022-07-12info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/pdfhttps://periodicos.ufmg.br/index.php/reme/article/view/3942510.35699/2316-9389.2022.39425REME-Revista Mineira de Enfermagem; Vol. 26 (2022)REME-Revista Mineira de Enfermagem; Vol. 26 (2022)REME-Revista Mineira de Enfermagem; v. 26 (2022)2316-93891415-2762reponame:Reme (Online)instname:Universidade Federal de Minas Gerais (UFMG)instacron:UFMGporenghttps://periodicos.ufmg.br/index.php/reme/article/view/39425/30889https://periodicos.ufmg.br/index.php/reme/article/view/39425/30890Copyright (c) 2022 REME-Revista Mineira de Enfermagemhttps://creativecommons.org/licenses/by/4.0info:eu-repo/semantics/openAccessTruzzi, Ingrid Gomes de CamposJericó, Marli Carvalho Lima, Antônio Fernandes Costa Zunta, Raquel Silva Bicalho Oliveira, Débora Soares de Romcy, Helena Maria2023-03-30T17:09:02Zoai:periodicos.ufmg.br:article/39425Revistaremeufmg@gmail.comPUBhttps://periodicos.ufmg.br/index.php/reme/oairemeufmg@gmail.com2316-93891415-2762opendoar:2023-03-30T17:09:02Reme (Online) - Universidade Federal de Minas Gerais (UFMG)false |
| dc.title.none.fl_str_mv |
The influence of records on medical charts as a factor associated with technical disallowances La influencia de los registros en la historia clínica como uno de los factores que se asocia al fallo técnico hospitalario A influência dos registros do prontuário como um dos fatores associados à glosa técnica hospitalar |
| title |
The influence of records on medical charts as a factor associated with technical disallowances |
| spellingShingle |
The influence of records on medical charts as a factor associated with technical disallowances The influence of records on medical charts as a factor associated with technical disallowances Truzzi, Ingrid Gomes de Campos 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 Truzzi, Ingrid Gomes de Campos 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 |
| title_short |
The influence of records on medical charts as a factor associated with technical disallowances |
| title_full |
The influence of records on medical charts as a factor associated with technical disallowances |
| title_fullStr |
The influence of records on medical charts as a factor associated with technical disallowances The influence of records on medical charts as a factor associated with technical disallowances |
| title_full_unstemmed |
The influence of records on medical charts as a factor associated with technical disallowances The influence of records on medical charts as a factor associated with technical disallowances |
| title_sort |
The influence of records on medical charts as a factor associated with technical disallowances |
| author |
Truzzi, Ingrid Gomes de Campos |
| author_facet |
Truzzi, Ingrid Gomes de Campos Truzzi, Ingrid Gomes de Campos Jericó, Marli Carvalho Lima, Antônio Fernandes Costa Zunta, Raquel Silva Bicalho Oliveira, Débora Soares de Romcy, Helena Maria Jericó, Marli Carvalho Lima, Antônio Fernandes Costa Zunta, Raquel Silva Bicalho Oliveira, Débora Soares de Romcy, Helena Maria |
| author_role |
author |
| author2 |
Jericó, Marli Carvalho Lima, Antônio Fernandes Costa Zunta, Raquel Silva Bicalho Oliveira, Débora Soares de Romcy, Helena Maria |
| author2_role |
author author author author author |
| dc.contributor.author.fl_str_mv |
Truzzi, Ingrid Gomes de Campos Jericó, Marli Carvalho Lima, Antônio Fernandes Costa Zunta, Raquel Silva Bicalho Oliveira, Débora Soares de Romcy, Helena Maria |
| dc.subject.por.fl_str_mv |
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 |
| topic |
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 |
| description |
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. |
| publishDate |
2022 |
| dc.date.none.fl_str_mv |
2022-07-12 |
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info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion |
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article |
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publishedVersion |
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https://periodicos.ufmg.br/index.php/reme/article/view/39425 10.35699/2316-9389.2022.39425 |
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https://periodicos.ufmg.br/index.php/reme/article/view/39425 |
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10.35699/2316-9389.2022.39425 |
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por eng |
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por eng |
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https://periodicos.ufmg.br/index.php/reme/article/view/39425/30889 https://periodicos.ufmg.br/index.php/reme/article/view/39425/30890 |
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Copyright (c) 2022 REME-Revista Mineira de Enfermagem https://creativecommons.org/licenses/by/4.0 info:eu-repo/semantics/openAccess |
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Copyright (c) 2022 REME-Revista Mineira de Enfermagem https://creativecommons.org/licenses/by/4.0 |
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openAccess |
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application/pdf application/pdf |
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Universidade Federal de Minas Gerais |
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Universidade Federal de Minas Gerais |
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REME-Revista Mineira de Enfermagem; Vol. 26 (2022) REME-Revista Mineira de Enfermagem; Vol. 26 (2022) REME-Revista Mineira de Enfermagem; v. 26 (2022) 2316-9389 1415-2762 reponame:Reme (Online) instname:Universidade Federal de Minas Gerais (UFMG) instacron:UFMG |
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Universidade Federal de Minas Gerais (UFMG) |
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UFMG |
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UFMG |
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Reme (Online) |
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Reme (Online) |
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Reme (Online) - Universidade Federal de Minas Gerais (UFMG) |
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remeufmg@gmail.com |
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1822180941440745472 |
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10.35699/2316-9389.2022.39425 |