CAUSES AND MITIGATION STRATEGIES FOR HOSPITAL DISALLOWANCES: AN INTEGRATIVE REVIEW

Abstract

Hospital disallowances, characterized by the rejection of bills sent to payers, generate significant revenue losses and require precision in the billing process to minimize these impacts. This study conducted an integrative literature review to investigate the causes of disallowances and identify mitigation strategies applicable in hospital settings. The research was conducted between June and August 2024, using the Medline (via PubMed®), Virtual Health Library (VHL), Scientific Electronic Library Online (SciELO) and Scopus databases, resulting in 11 selected studies. The causes were grouped into four main categories: Administrative, Registration, Educational and Management, with nursing records standing out as a central element, given their direct impact on document compliance and hospital billing. The mitigation strategies were classified into seven categories: (1) Education, (2) Auditing, (3) Process Improvement, (4) Administrative, (5) Indicators, (6) Communication, and (7) Innovation. The performance of the health manager is essential for the implementation of these strategies, ranging from operational planning to team training, with the objective of creating an environment of document compliance and promoting continuous improvements in hospital billing, ensuring financial sustainability and patient safety.

DOI: https://doi.org/10.56238/sevened2024.041-024