• Title/Summary/Keyword: 진료비 심사 청구

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A Study on the Development and Implementation of a Data-mining Based Prototype for Hospital Bill Claim Reduction System (데이터마이닝 기법을 활용한 의료보험 진료비청구 삭감분석시스템 개발 및 구현에 관한 연구)

  • Yoo, Sang-Jin;Park, Mun-Ro
    • Information Systems Review
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    • v.7 no.1
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    • pp.275-295
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    • 2005

  • Changes in business environment caused by globalization of the world economy and the beginning of the knowledge society forced hospitals to equip with tools for the enhanced competitiveness. In other words, hospitals must aim three targets such as acquisition of advanced medical skills and equipments, improvement of service level for patients, and achievement of superior managerial performance simultaneously. This study has been done to suggest a way to reduce the possibility of hospital bill claim reduction as an alternative for the achievement of superior managerial performance. If the reduction rate of hospital bill claim is high, it will put negative impact on the hospital's revenue stream and hospital's reliability. Thus, if they want to stay competitive, hospitals need to device ways to cut the reduction rate as much as possible. In this study, a prototype system has been developed and implemented to check the possibility to cut the reduction rate through deep analysis of causes of reduction. The prototype first developed utilizing data mining techniques and the relation rules algorithm. Then the prototype was tested its performance using the D hospital's live data.

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The Development of Educational program on NCS-Based Medical expense management and Examination claim (의료정보시스템을 활용한 NCS 기반 진료비 관리 및 심사청구 교육프로그램 개발)

  • Choi, Joon-Young
    • The Journal of the Korea institute of electronic communication sciences
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    • v.11 no.10
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    • pp.1009-1016
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    • 2016

  • In this study, an educational program was developed. The program can perform the claim for examination of medical expense, which is one of NCS Competence Unit Elements for hospital administration. Considering various coding to complex compute and process, VB.Net was employed for this development. For database, ACCESS Database was used because it is easy to learn and use. The learning effects by the developed program are expected to be as follows. First, the composition of medical expense can be understood by analyzing Medical history and then selecting insurance code according to the Standard of Medical Care Code. Second, unit cost per score can be learned according to hospital class. Third, selection of Column (medical materials) and Column II(medical practice) can classify items of additional ratio. Fourth, because patient's payment rate on hospitalization and meal expense and use of special equipment are differently applied, user can know patient's payment rate by type and can calculate it. Fifth, additional amount is the amount calculated by additional ratio of Column II(medical practice), and user can learn additional ratio according by insurance type and hospital class. Sixth, user can learn self-pay rate by hospital class and understand the process that self-pay amount and claim amount are calculated according by self-pay rate.

  • https://doi.org/10.13067/JKIECS.2016.11.10.1009 인용 PDF KSCI