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KMID : 0365420080270010033
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Journal of the KLIMA
2008 Volume.27 No. 1 p.33 ~ p.36
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A study on the typology of the medical claims review in terms of hospital department
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Lee Sin-Hyung
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Abstract
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Backgound: The medical claims review(MCR) is unique methodology of medical consultation in terms of insurance claim administration in Korean insurance market. The most important practical matter in the MCR is formatted question. In Korea, medical specialty is composed of 26 legally defined hospital departments. It is worth of studying to investigate type of MCR by hospital departments.
Methods: Fifty Cases of the MCR were selected randomly by statistical program SPSS among 1,032 cases which were performed between April 1, 2006 and March 31 2007. All of selected cases were evaluated one insurance doctor and made a score points from 0 to 10 in terms of hospital department.
Results: Multidimensional scaling was performed. The MCR types - diagnosis, malignancy and cause of death are located in the same 2-dimensional configuration area. It can be called as verification of benefit. Others are advice. - such as causality, interpretation, translation, independent medical examination, and so on.
Discussion: We can conclude the classification of MCR typology are two main subjects, verification and advice. Theses results are same as previous article which was based on experience.
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KEYWORD
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insurance medicine, medical claims review, multi dimensional scaling
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