Analysis of a Healthcare Organization's Physician Billing System Overpayment Refund Process.

摘要

The problem that was addressed in this study was the current physician billing system overpayment refund process creates errors in the distribution of funds at a healthcare organization. The purpose of this quantitative, descriptive study was to analyze the output of the physician billing system overpayment refund process in a large-scale government-supported hospital and determine errors in the distribution of funds. The study has business implications related to financials, customer satisfaction, compliance, and use of resources. The foundation of this study was based on the error theory, systems theory, and technology evolution theory. The research questions examined (a) if the error rate of the overpayment refund process was satisfactory based on Six Sigma methodology, (b) the number of days needed to process an overpayment refund, and (c) the frequencies of error types. The scope of this study was limited to 2,999 transactions from the physician billing system that resulted in the following conclusions: (a) the observed error rate (4.03%) was higher than the 0.03% error rate advocated by Six Sigma and validated with a z-test, (b) the average number of days needed to process a refund (12.37 days) was less than the target level of 30 days with validation from a t-test, and (c) not all error types were equally likely. The results offer implications for positive social change by providing data to support a need for a standardized protocol, possibly leading to fewer errors; therefore, having financial implications not only to the hospital, but also to the community.