Action plan for the proper completion of clinical records to reduce patient medical insurance claim rejections.

Abstract

This research addressed the problem of inadequate clinical record completion and its relationship to the occurrence of glosses by health insurance companies. The overall objective was to design an action plan for the correct completion of clinical records in order to reduce glosses. The methodology used combined descriptive and documentary techniques with a quantitative approach based on the review of clinical records and gloss records. The results showed that the main errors in the records included omissions in clinical data, incorrect dates, missing signatures, and inadequate coding. The proposed action plan included training for healthcare personnel, implementation of standardized formats, continuous supervision, and periodic audits, with the goal of ensuring correct clinical documentation and significantly reducing glosses. The Expert Judgment Assessment found that the opinions of those evaluated were positive, highlighting that the correct completion of clinical records is presented as a comprehensive strategy that systematically addresses the errors and deficiencies that currently generate glosses by health insurance companies. It was concluded that the implementation of this plan can improve the quality of clinical records, increase administrative efficiency and strengthen the relationship with health insurance companies.