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KMID : 0365420050240010027
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Journal of the KLIMA
2005 Volume.24 No. 1 p.27 ~ p.42
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Assessment of malignity in medical claims review
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Lee Sin-Hyung
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Abstract
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Among medical claims review, decision of malignancy is very important. According to the pathologic report may be ordinary pathway. Some tumors are not completely studied especially malignancy. Wheather malignancy or benign is the important thing in medical claims review. We here disscuss on the debatable tumors such as carcinoid tumor, gastrointestinal stromal tumor (GIST), desmoid tumor, MALToma, and pseudomyxoma peritonei. Another controversial subject in the medical claims review is selection of pathologic report. If the result of the pathologic report is not same in one patient, We prefer the selsection of the report from more professional hospital. We have called this professional hospital l as "third hospital" or ’refferal hospital".
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KEYWORD
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claim, malignancy, decision, insurance medicine
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