Orliński, Ryszard
July 2015
Research Papers of the Wroclaw University of Economics / Prace N;2015, Issue 398, p391
Academic Journal
The introduction of payments for medical services and medical procedures based on a system of homogeneous groups of patients improved the financial settlements of hospitals with the NFZ. Billing system allows to combine financial and medical aspects, and at the same time to control the cost of assigning them to specific disease entities and patients. For each procedure and diagnosis the appropriate number of points is assigned as the basis for the clearing-financial connection contract. Encoding a relevant patient with the disease entity it should be remembered to include all relevant information affecting the amount of the credits, and assigned to it the reimbursement rate (price for completed medical service = number of points x price per point). Gruper is an application that allows the classification of the patient's record (on an individual basis) to an appropriate group of DRG system. The correctness of the data input determines the assignment of the appropriate number of points, and thus obtaining the maximum possible amount for the realized health service. The aim of this article is to present the possibilities of settling medical procedures using Gruper applications. The content of the article used information from surveyed hospitals (research subjects), as part of research conducted by the author. The results of the research support the need for accuracy in coding patients and procedures, using tools and computer programs, which makes it possible to obtain the maximum possible amounts due to the realized health benefits from the NFZ.


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