Quality Improvement of Recording in a Medical Reimbursement Claiming System, Nursing Department of Special Treatment, Lamphun Hospital

Abstract

           Accuracy and complete recording in a Medical Reimbursement Claim System (MRCS) is ofgreat benefit to hospital revenues. The purpose of this developmental study was to improve the quality of MRCS recording at the Nursing Department of Special Treatment, Lamphun Hospital. This study’s methodology was guided by the FOCUS-PDCA quality improvement process which consists of 9 steps: find a process to improve; organize a team that knows the process; clarify current knowledge of the process; understand causes of process variation; select processes for improvement; plan the improvement; do the improvement; check and evaluate the results; and act to maintain the improvement. The study population included 11 registered nurses. The research instruments included a guideline for recording medical reimbursement claims, an assessment form for practice compliance with the guidelines of the reimbursement claims record, and a record form for the length of completed data in the MRCS. Data were analyzed by descriptive statistics.
          The results showed that following the guidelines for recording medical reimbursement claims enabled an increase in the accuracy and completion of data in the MRCS. After all professional nurses attended the compliance training, the MRCS data attained 100% accuracy. All completed data was submitted to the warehouse within 30 days after patient discharge.
           The results of this showed that the application of the FOCUS-PDCA quality improvement
process could increase the accuracy and completion of data and enable timely submission to the MRCS. Nurse administrators should apply the FOCUS-PDCA quality improvement process to improve other medical recording systems in hospitals, and ensure continuous follow-up compliance with guidelines for recording medical reimbursement claims as needed.