Interactive data exploration system to examine the application of medical insurance benefits

Interactive data exploration system to examine the application of medical insurance benefits

An Interactive Data Exploration System for Auditing Health Insurance Reimbursement Claim

徐珮岚

Jen Chiang

I-Jen Chiang

a

Institute of Medical Informatics, Taipei Medical University,

National Taiwan University, Institute of Biomedical Engineering

Abstract

Reporting process in medical payments, some abuse of error, such as: coding error (Miscoding) or encoding of high reported (Up-

Cording), primary and secondary diagnosis of inverted (Diagnosis Sequencing), improper cutting (Unbundling of Services), the file does not complete (Missing Documentation), non-essential medical services (Medical Necessity), examination and radiological

procedures and coding errors, often tricky to get a higher medical benefit, and seriously affected the fairness of the overall payment of medical expenses. Although there are thousands of standards to regulate medical care steps, such as drug use and so on. However lacking in an automated decision system can be applied to health insurance to pay assignment.

In dealing with a large number of medical information operations, to full and fair dealing with a lot of medical information, an

automated insurance, please pay check and review system is very important. An automated system can reduce the economical and rapid manual operation when the bias and error. In particular, the computer system can simplify the review of operating procedures and audit time, the medical institutions and clinics is quite effective.

By fast operating speed, medical institutions and clinics may also reduce the waiting time of payment.

This paper is to investigate the technical and visual data

classification techniques to set up this type of automated insurance claims auditing system.

Keywords: visualization, medical decision support, health insurance review, data exploration