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Computer-implemented method for grouping medical claims with clinically representative dynamic clean periods
Computer-implemented method for grouping medical claims with clinically representative dynamic clean periods
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机译:用计算机执行的方法对具有临床代表性的动态清洁期的医疗索赔进行分组
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摘要
A computer-implemented method for profiling medical claims to assist health care managers in determining the cost-efficiency and service quality of health care providers. The method allows an objective means for measuring and quantifying health care services. An episode treatment group (ETG) is a patient classification unit, which defines groups that are clinically homogenous (similar cause of illness and treatment) and statistically stable. The ETG grouper methodology uses service or segment-level claim data as input data and assigns each service to the appropriate episode. The program identifies concurrent and recurrent episodes, flags records, creates new groupings, shifts groupings for changed conditions, selects the most recent claims, resets windows, makes a determination if the provider is an independent lab and continues to collect information until an absence of treatment is detected.
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