Analysis of Insurance Challenges and Formulation of Solutions to Reduce them in Revenue Management of Educational Hospitals at Ardabil University of Medical Sciences: A Qualitative Study

Authors
Paria Khulusi
Hamid bargi
Sorayya Rezayi
Naser sepehrzadeh
Roya Naemi
Abstract
Introduction: Hospital financial management is crucial due to limited resources and the need to provide services to the community. Insurance-related financial deductions pose significant challenges to hospital financial management. The present study was conducted with the aim of identifying the causes of insurance deductions in Ardabil teaching hospitals and explaining strategies for controlling and reducing them.

Methods: This study employed a qualitative content analysis approach. The statistical population consisted of 23 experts from the medical records and hospital income department, basic insurance supervisors, and officials from the economics unit of the vice-president of treatment at Ardabil University of Medical Sciences. The research sampling was done using the snowball method. The data were collected using semi-structured interviews. MAXQDA software was used to code and create a conceptual connection between the answers provided, and the grounded theory method was used for content and deeper analysis of the topics.

Results: After going through the coding process of the concepts resulting from creating a connection with the interviewees' answers using the relevant software, the causes of deductions were identified and categorized into two main categories, 11 subcategories, and 72 items. The two main categories include intra-organizational and extra-organizational. Failure to record or incorrect recording of information by doctors and medical staff, failure to comply with scientific indications, incomplete or excessive recording in the HIS system, lack of manpower, lack of equipment, weakness of HIS support companies, problems with the pharmaceutical system, complexity of the Ministry of Health and Food and Drug Safety regulations, time lag in implementing guidelines, challenges with insurance organizations, and low motivation of subclass employees are the causes of deductions.

Conclusion: An efficient revenue cycle typically looks at all components of the revenue cycle in an integrated manner, including workforce, technology, and process-related organizations. A successful revenue cycle relies on technology, management processes, employee capabilities and motivation, and organizational culture to lead to financial stability and sustainability, increased cash flow, and increased efficiency and accuracy in delivering services to patients.
Keywords
Hospital Deductions
Revenue Management
Challenge
content analysis
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