REVIEW

Hospital Deductions, Types and Causes

Mohamad Taghi Mousarrezaei, Leila Doshmangir, Ali Jannati, Ali Imani

Mohamad Taghi Mousarrezaei
Student Research Committee, Faculty of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran

Leila Doshmangir
Department of Health Care Management, Iranian Centre of Excellence in Health Management, Health Services Management Research Centre, Faculty of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran

Ali Jannati
Department of Health Care Management, Iranian Centre of Excellence in Health Management, Health Services Management Research Centre, Faculty of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran

Ali Imani
Department of Health Care Management, Iranian Centre of Excellence in Health Management, Health Services Management Research Centre, Faculty of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran. Email: Maimani58@gmail.com
Online First: April 23, 2019 | Cite this Article
Mousarrezaei, M., Doshmangir, L., Jannati, A., Imani, A. 2019. Hospital Deductions, Types and Causes. Bali Medical Journal 8(2). DOI:10.15562/bmj.v8i2.551


Objective: The current study aims to provide valid information about the causes and types of hospital deduction records via a systematic review.

Method: This systematic review was performed by searching the databases including PubMed, Scopus, Science Direct, Ovid, Medline, Cochrane, ProQuest, and IranMedex, Magiran, Sid, and Medlib databases for studies without time limitation. Updates were added to the searches during the study. Search strategies included the combination of keywords including “Billing error” OR “Deductive” OR “Error payment” OR “Insurance claim” OR “Medical claim” OR “Improper payment” OR “Insurance reimbursement” OR “Medical payment” OR “payment error” with “Hospital” and “medical records”. The reference lists of each article were manually searched to find additional relevant articles. All records without time limitation, those written in Persian and English, and the ones investigating the types and causes of deductions in hospital inpatient bills records were included. To determine the eligible records, two authors extracted the data independently; and discrepancies were resolved through discussion or, if required, through consultation with a third author. The quality of the articles was analyzed using STROBE checklist.

Results: The search strategy yielded 1,264 records from electronic databases, and 15 records were identified by the manual search. After removing the duplicates and screening the database by titles and abstracts, 39 of these records remained. The full text of these 39 records was checked and, finally, 22 of them met inclusion criteria. The major causes of deductions in the documentation included human errors, incomplete document registration, documentation errors, added prices, added request, and calculation errors.

Conclusions: Education and cooperation of staff and collaboration of all stakeholders such as hospitals, insurance organizations, and related staff in this field are necessary for conducting a substantial action to reduce hospital deduction.

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