Auditoría de cuentas médicas como eje fundamental para el proceso de facturación en salud
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Martínez Cogollo, Luis Enrique | 2020-11-20

The medical accounts audit process improves the billing process through the
performance of technical, evaluative and preventive procedures, basing its activities
on the components of structure, process and result, constituting within the process,
the clinical record or the medical history the cornerstone. In addition, its responsibility
to issue corrective measures or continuous improvements aimed at quality of care
is established, all in order that the entity responsible for payment does not find any
flaw when performing the external audit of the account and thus carry out the
respective payment of care.
Thus, the audit is conceived as the expert analysis and systematic evaluation of the
billing of the health services provided by the IPS, carried out by the Medical Auditors
with the fundamental objective of identifying and solving deviations in the billing
process and the relationship between The different actors in the health system have
as their starting point the agreements established between the Benefit Plan
Management Entities (EAPB) and the IPS.
The audit of medical accounts observes the need for EPS and IPS to integrate the
health care process with the invoices that demonstrate their collection. This activity
manages to interrelate the validation of: the provision of services, application of the
scientific knowledge of professionals, the use of diagnostic and therapeutic aids and
the real costs of the services billed, among others.
The objective of this research is to evaluate the audit of medical accounts as a
fundamental axis for the good process of billing in health, identifying the generalities
of the audit of medical accounts to avoid glosses or returns by the entities
responsible for payment, in turn medical account protocols are verified for detailed
review before being filed with the entity in charge of payment and finally the billing
process in the entities providing health services is explained
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