O grande desafio de todo gestor de instituições de saúde é o de fechar as planilhas de gastos e de entradas. Neste cenário surge um dos maiores problemas financeiros enfrentados pela empresa: a falta de pagamento por serviços realizados aos convênios, ou glosa médica.

Tal situação é passível de recurso ao prestador, mas o atraso da quitação é inevitável e o dinheiro acaba não chegando na conta.

Quer saber o que é glosa médica, como ela afeta o faturamento e como reduzir esse fenômeno? Então acompanhe nosso artigo!

Conheça a glosa médica e como ela pode ser classificada

Podemos definir como glosa aquele procedimento em que foi solicitada uma explicação complementar às informações acerca do serviço, seja ele realizado pelo convênio médico ou pelo plano de saúde.

Na prática, é visto como a falta de compatibilidade entre o procedimento que foi descrito no formulário de atendimento em relação ao procedimento que foi combinado com convênio médico.

As glosas podem ser classificadas como:

Administrativas

São causadas por falhas operacionais no ato da cobrança, falta de interação entre o plano de saúde e o prestador de serviços, ou mesmo a falha no momento da análise de conta do prestador.

Técnicas

Aquelas relativas à apresentação dos valores de contratos, medicação, serviços e procedimentos médicos realizados.

Lineares

Recorrentes de uma postura unilateral dos convênios médicos ou planos de saúde.

A glosa médica afeta diretamente o faturamento do operador de saúde, cabendo a realização de auditorias para investigar as propriedades dos gastos e processos de pagamentos, análise de dados, indicadores operacionais e conferência dos sistemas de faturamento das contas médicas.

Essa dinâmica está cada vez mais frequente no mercado de prestação de serviços de saúde e tem se mostrado fundamental para evitar erros e futuras glosas.

Saiba como reduzir a glosa médica

Confira algumas dicas para ajudar a reduzir a glosa e aumentar seu faturamento:

Adote um sistema de prontuário eletrônico

Utilizar prontuários eletrônicos é uma excelente maneira de reduzir a ocorrência de glosas dentro das instituições de saúde. A maior parte das glosas médicas são causadas por erros durante o preenchimento de prontuários, prescrições e solicitações.

Trocar os prontuários escritos à mão por um sistema de prontuário eletrônico diminui consideravelmente o número de erros de escrita e interpretação, não havendo mais problema com letras ilegíveis.

A instalação de um sistema digital que adota o prontuário eletrônico permite muito mais eficiência para a instituição, pois permite que os funcionários acessem as informações do paciente a partir de qualquer dispositivo com acesso à internet.

Desta forma, os prontuários eletrônicos favorecem a realização de diagnósticos mais precisos, a padronização de serviços médicos e favorecem o sistema de acreditação hospitalar.

Realize auditorias internas

É muito importante formar equipes de auditoria em gestão administrativa e financeira, buscando garantir a excelência em qualidade de serviço e o estabelecimento de normas que são exigidas pelos convênios de saúde.

Tais equipes devem ser treinadas em gestão hospitalar, gestão em saúde e relacionamento com médicos e demais profissionais para entender como funcionam os registros de pacientes e o envio dos relatórios às operadoras.

Busque eficiência nas autorizações de serviços e procedimentos

Os operadores de planos de saúde devem implementar um sistema que permita alertar a equipe médica do hospital caso ocorram possíveis incompatibilidades entre o procedimento solicitado por eles e os critérios adotados pelos operados de saúde e convênios médicos.

Desta forma, estabelecem um conjunto de dados que servirão como ferramenta para tomar decisões dali em diante. Adotar um sistema digital que utilize de uma conferência eletrônica com os dados permite maior atenção ao fazer a prescrição de procedimentos e medicamentos, impactando diretamente na redução das glosas médicas.

Adquira um sistema de gestão hospitalar integrado

A tecnologia é uma excelente ferramenta para implementar um sistema de gestão hospitalar que integre todos os setores, melhore o fluxo de comunicação e agilize os serviços.

Os sistemas integrados têm como objetivo evitar erros — como o cadastramento incompleto dos pacientes —, alertar sobre o número do cartão do convênio caso seja inválido ou vencido e verificar se a quantidade de medicamentos no estoque é compatível com o número de procedimentos realizados.

Outra vantagem que o sistema possibilita é a de informar o valor dos procedimentos e medicamentos usados antes de enviar os relatórios aos convênios, que é mais uma forma de evitar as glosas técnicas.

Para atender às exigências dos convênios à risca, outra boa solução é a de adotar o controle automático de anotações laboratoriais e de automatizar os processos internos do hospital. Isso permite a criação de um pacote de documentos e de formulários eletrônicos, todos feitos de forma automática e já conferidos.

A automatização das anotações laboratoriais ainda é muito útil nas situações em que a instituição de saúde necessite recorrer judicialmente ao reembolso caso algum procedimento feito não seja pago pelo convênio sem qualquer razão plausível, evitando, assim, a glosa linear.

Foque em qualidade nos laudos médicos

Quando falamos em reduzir a glosa médica do faturamento para operadoras de saúde, é fundamental abordar o controle de qualidade dos laudos médicos produzidos. A emissão desses laudos está entre as áreas que mais sofre impacto da tecnologia, tendo um papel mais vantajoso ainda no exercício da medicina.

Muitas glosas poderiam ser evitadas caso não acontecessem tantas falhas operacionais nos laudos médicos. O resultado desses erros é visto como o atraso do pagamento pelos convênios, quando é feita a análise das contas do prestador de serviços.

Utilizar um sistema de gestão de laudos médicos é importante para evitar as glosas médicas e suas consequências terríveis no setor financeiro do hospital.

Evitar todos tipos de glosas, sejam elas administrativas, técnicas ou lineares, é uma tarefa difícil que demanda envolvimento de todos os setores da instituição de saúde e não apenas o financeiro.

Além disso, evitar as glosas médicas e seus impactos no faturamento depende, diretamente, de uma normatização das operações, do seguimento de regras, da realização de auditorias e de utilizar as tecnologias como aliadas para evitar erros.

Gostou do nosso conteúdo? Ainda tem alguma dúvida? Siga nossa página no Facebook e se mantenha bem-informado sobre o assunto!

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Como reduzir a glosa médica do faturamento para operadoras de saúde?
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Como reduzir a glosa médica do faturamento para operadoras de saúde?
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Quer saber o que é glosa médica, como ela afeta o faturamento e como reduzir esse fenômeno? Então acompanhe nosso artigo!
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