Korea Journal of Hospital Management (한국병원경영학회지)
- Volume 7 Issue 3
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- Pages.121-136
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- 2002
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- 1226-6299(pISSN)
Hospital's Internal Review Procedure of Health Insurance Reimbursement
병원의 진료비 청구 자체심사 과정과 이의신청 사례
- Choi, Gil-Lim (Department of Health Care Administration, Inje University) ;
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Kim, Won-Joong
(Inje University Paik Hospital)
- Published : 2002.09.30
Abstract
The main purpose of this study is to examine the overall procedure of hospital's internal review of health insurance reimbursement, to present the case of protest against reimbursement cut, and hence to provide some information on hospital's management of medical revenue. The object of the case study is 'P' university medical center, possessing 5 different hospitals under its system. Presentation of the case of protest against reimbursement cut has following meanings: Firstly, to the hospitals that already have internal review departments, information on the details of the protest process and results can be exchanged. Secondly, to the Government and National Health Insurance Corporation, useful data are provided for the improvement of the rules and procedures of health insurance reimbursement. Thirdly, to the hospitals without internal review departments, fundamental materials on the internal review process are provided for the effective management of medical revenue.
Keywords
- health insurance reimbursement;
- internal review;
- protest against reimbursement cut;
- management of medical;
- revenue