HIRA

심사효율화 방안 개발 연구

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Type
Book
Author(s)
건강보험심사평가원
Issued Date
2004-09
Publisher
건강보험심사평가원
URI
https://repository.hira.or.kr/handle/2019.oak/2623
Table Of Contents
Ⅰ. 서론.....................................................................................................................................1

Ⅱ. 용역연구 결과의 신뢰성 검토.................................................................................... 4
1. 용역연구 결과 요약................................................................................................ 4
2. 용역연구의 제한점...................................................................................................8
3. 용역연구 결과의 검증(입원)................................................................................11
4. 용역연구 결과의 검증(외래)..................................................................................... 14

Ⅲ. 입원 심사대안의 모색................................................................................................. 20
1. 1차 분석................................................................................................................... 20
2. 2차 분석 .......................................................................................................... 26
3. 입원 심사지표 적용에 따른 보완 검토............................................................. 29
4. 입원 심사지표 산출기준.......................................................................................54

Ⅳ. 외래 심사대안의 모색 ................................................................................................ 59
1. 개요............................................................................................................................59
2. 심사대안별 심사건수 및 조정률 변화.............................................................. 60
3. 분리청구에 대한 검토.......................................................................................... 80
4. 방문일수별 진료비고가도지표(CI)의 검토........................................................83

외래환자 질병군분류체계.................................................................................. 95
열외군 분석........................................................................................................ 112
Publisher
건강보험심사평가원
Location
KOR
Citation
[1]건강보험심사평가원, 심사효율화 방안 개발 연구. 건강보험심사평가원, 2004.
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HIRA 발간 > 5. 기타 발간물
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