فهرست نشریات علمی دسترسی آزاد ایران

Background and Objectives: Hospital reimbursement is a critical component of the hospital financial system that directly impacts hospital cash flow and profitability. Given the increasing medical costs and financial pressures, reducing deductions due to errors and mistakes in reimbursement processes is of great importance. The purpose of this study is to accurately and transparently analyze the factors affecting deductions and identify weaknesses in hospital financial and administrative processes.    Methods: This study was conducted to examine the extent and causes of deductions in inpatient files and to improve the hospital reimbursement process for patients who encountered deductions during the years 2022-2023. The research community includes experts involved in hospital deductions and handling hospital bills, including hospital supervisors and revenue unit experts or financial affairs experts in a selected teaching general hospital in Tehran in 2023. It used the Six Sigma approach as a process optimization method. The intervention was carried out by implementing the phases of the Six Sigma method in the hospital.   Results: In this study, the reimbursement process was examined from the time of patient admission, recording medical information, calculating costs, sending information to insurance, and finally receiving payments. By implementing the phases of the Six Sigma method, the number of cases examined and the total amount of deductions in the year 2023 have decreased significantly. These changes have also caused the average monthly deduction percentage to decrease from 1.33% in 2022 to 0.82% in 2023.    Conclusion: The results of this study showed that the use of Six Sigma in improving the hospital reimbursement process significantly reduced financial deductions. Also, by improving the speed of processes, the time for reimbursements was reduced, which led to increased patient satisfaction and reduced financial pressure on the hospital. Overall, the results of the study indicate that the careful implementation of Six Sigma methods can significantly increase hospital productivity and reduce unnecessary costs, while maintaining the quality of services to patients.