J Korean Soc Med Inform.
2003 Mar;9(1):63-72.
Development of a Decision Support Program to minimize Health Insurance Claims Reject: 20% albumin infusion and perineal care procedure
- Affiliations
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- 1Young-Dong Severance Hospital, Korea. coordinurse2@yumc.yonsei.ac.kr
- 2Nursing College, Younsei University, Korea.
- 3Graduate School of Health Science and Management, Yonsei University, Korea.
Abstract
- This study was focused on developing a computerized decision support program for physician order entry of 20% albumin infusion and perineal care procedures in order to minimize inpatients'insurance claims rejects. The frequency of inpatients health insurance reimbursement claims rejects of a 800-bed tertiary care teaching university hospital in Seoul area was reviewed and the most common two orders of the reject were chosen for the study. The order decision support program was designed on the basis of Korean Health Insurance Reimbursement Guidelines. The server system used for the study was ProLiant 7000 and Pentium III was used for the program development. Windows 2000 was used as the operating system, MS SQL v7.o was used for the database. The software development languages were Visual basic V6.0 and Spread v3.0. This Decision Support Program was proven to be very useful when doctors and nurses wanted to reflect the Health Insurance Reimbursement Guidelines in their ordering practices.
