Auditing hospital bills: an analysis of the main reasons of glosses in a private institution

• Main Authors: Marinaldo Pereira dos Santos, Chennyfer Dobbins Paes da Rosa
• Format: Article
• Language: Portuguese
• Published: Pontifícia Universidade Católica de São Paulo 2013-12-01
• Series: Revista da Faculdade de Ciências Médicas de Sorocaba
• Subjects: auditoria administrativa; administração hospitalar; administração financeira de hospitais; hospitais privados
• Online Access: http://revistas.pucsp.br/index.php/RFCMS/article/view/17653

ABSTRACT Objective: costs auditing is considered fundamental for the survival of health institutions. Thus, this article aims to investigate the reasons for glosses which occurred in a hospital in São Paulo, capital. Methods: data survey included the glosses identified from its resources, along with a health care operator. Results and Discussion: nine hundred and twenty-one glossed items were found in the analyzed resources, whose total value was of R$173,603.36. Ninety-one percent of the resources concern administrative glosses and 9% concern technical glosses. As for the value appealed, around 22% are accepted. Final results reveal that 75% of the glosses can be avoided. Conclusion: most of the reasons for the glosses analyzed concern failures in the patient-care, administrative and paying resources areas. In order to obtain a successful result, it is necessary that the manager perform a critical analysis of the reasons for glosses, thus making people aware of the problems caused by glossing and developing action plans for solving them