| 摘要 |
Rate schedules specify payment mechanisms and rates based upon which healthcare service providers are compensated for services by insurers. The invention provides a tool for predicting the total compensation under a rate schedule based upon expected levels of service utilization for a provider during a time period. Service utilization levels characteristic of the provider are supplied for a relatively small number of general classes of medical services. Aggregate utilization data that is collected from multiple service providers by government authorities provides a reliable distribution of data that is based upon a large population and that is specifically categorized using hundreds of DRG codes. The specifically categorized aggregate utilization data is scaled based upon the general utilization levels of the provider to create a predicted set of service utilization data. The rate schedule is applied to the predicted set of service utilization data to determine total compensation.
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