Regulatory Requirements and Health Care Codes

Kline, Jacob

doi:10.1016/b978-0-12-415145-1.50028-1

Cited by 1 publication

(1 citation statement)

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“… Integrating the coding policy like DRG or ICD10-CM [26][27][28][29],  Transforming some variables, such as the text data from the initial description of the pathology tests [30], and  Dealing with missing and outlier data [30].…”

Section: A Data Management Modulementioning

confidence: 99%

Development of a Decision Support System for Handling Health Insurance Deduction

Khademolqorani¹,

Hamadani²

2015

ijacsa

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Abstract-Effective hospital management involves such activities as monitoring the flow of medication, controlling treatment, and billing for the patient's treatment. A major challenge between insurance companies and hospitals lies in the way medical treatment expenses for insured patients are reimbursed. In some cases, the insurance deduction leads to the loss of revenues by hospitals. This paper proposes a framework for the handling insurance deduction that integrates three major methodologies: Decision Support Systems, Data Mining, and Multiple Criteria Decision Making. To exemplify the practical utility of the framework, it is used to study hospital services and insurance deductions are extracted from 200,000 documents in 150 hospitals in Iran. To classify the kinds of services, decision trees are developed to mine hidden rules in the data which are then modified on the basis of some performance measures. The rules are then extracted and ranked using the TOPSIS method. The results show that the proposed framework is capable of effectively providing objective and comprehensive assessments of insurance deductions.

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