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KMID : 1002520170110010027
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Korean Journal of Health Service Management
2017 Volume.11 No. 1 p.27 ~ p.42
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Insurance Claims Review and Assessment Task Effects on the Insurance Claims Reviewer and Evaluator in Hospitals
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Lee Ko-Eun
Kim Kyung-Hwa
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Abstract
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Objectives : This study analyzes the characteristics of hospital organization structures, insurance claims reviews and assessment tasks and their effects on hospitals in Pusan.
Methods : The data for this study were collected through interview and self-administered surveys in 109 hospitals. The study included only ? hospitals with a minimum of 50beds and excluded those providing only dental, psychiatric, or long-term care.
Results : The findings of this study state that the number of beds has an influence on the organizitional structure.
Conclusions : Hospital managements should seek human resources management(the insurance claims reviewer and evaluator) schemes that take into account the characteristics of the medical institution. In addition, insurance claims review and assessment tasks in hospitals require considerable knowledge and experience, and hospitals should be equipped with staff that have the relevant expertise. Therefore, to further deepen knowledge, comprehensive training 1should be continuously carried out in order to produce specialists in claims review and assessment.
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KEYWORD
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Insurance Claims, Claims Review & Assessment, Review & Assessment Task, Rate of Adjustment
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