在鼻科内对保险拒绝模式的多机构分析
Tyler A Janz1, Najm S Khan2, Aatin K Dhanda2
1Department of Otolaryngology-Head and Neck Surgery, University of Texas Medical Branch, Galveston, TX, USA.
American journal of rhinology & allergy
|March 28, 2024
概括
对于鼻科手术的保险拒绝率平均为2-3%,鼻腔内镜和脱bridement承担最高的成本. 实践必须监控报销变化,以减轻收入损失.
科学领域:
- 耳鼻喉科 耳鼻喉科 耳鼻喉科
- 医疗保健服务研究 医疗服务研究
- 医疗保健 金融 医疗保健 金融
背景情况:
- 保险批准在美国医疗保健中至关重要.
- 拒绝索赔可能会导致显著的收入损失 (3-5%).
研究的目的:
- 分析因鼻科手术而拒绝保险索赔的趋势.
- 确定拒绝率和财务影响最高的程序.
主要方法:
- 对3家机构 (2021年1月至2023年6月) 解除身份的财务数据的回顾性分析.
- 使用CPT代码查询用于鼻科和非鼻科手术的数据.
- 计算累计的保险拒绝和注销,按程序和付款人类型分层.
主要成果:
- 总共有102,984个程序被审查,最终拒绝率从2.2%到2.9%不等.
- 鼻子内镜,鼻子脱bridement/polypectomy,和鼻内病变破坏有最高的写出额度.
- 与医疗保险/医疗补助相比,商业保险支付人的 write-off 百分比较高.
结论:
- 鼻科手术拒绝率在2%到3%之间.
- 鼻子内镜和脱bridement是最昂贵的手术之一,由于拒绝.
- 鼻科诊所需要了解保险退款政策,以管理财务影响.
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