CLAIM-CENTRIC GROUPER ANALYSIS

摘要

Computer implemented systems and methods of health care claim data analysis are provided by storing a claim data set in a computer database, including patient information and a DRG assignment based on at least primary and secondary diagnosis codes. A nominal DRG weight is determined for the claim data set, using a processor in communication with the computer database. An alternate DRG weight is determined for the claim data set by swapping the primary and secondary diagnosis codes. A claim rating is generated for the claim data set, based at least in part on a difference between the nominal and alternate DRG weights. The claim rating is output to a user interface in communication with the processor.

主权项

1. A computer implemented method of health care claim data analysis, the method comprising:
storing a claim data set in a computer database, the claim data set comprising patient information and a DRG assignment based on at least a primary diagnosis code and a secondary diagnosis code; determining a nominal DRG weight for the claim data set with a processor in communication with the computer database, the nominal DRG weight based on the patient data in combination with the primary diagnosis code; determining an alternate DRG weight for the claim data set by swapping the primary and secondary diagnosis codes with the processor, wherein the alternate DRG weight is based on the patient information in combination with the secondary diagnosis code in place of the primary diagnosis code; generating a claim rating for the claim data set with the processor, wherein the claim rating is based at least in part on a difference between the nominal and alternate DRG weights; and outputting the claim rating to a user interface in communication with the processor.