Conceptual-driven classification for coding advise in health insurance reimbursement.

Objective: With the non-stop increases in medical treatment fees, the economic survival of a hospital in Taiwan relies on the reimbursements received from the Bureau of National Health Insurance, which in turn depend on the accuracy and completeness of the content of the discharge summaries as well as the correctness of their International Classification of Diseases (ICD) codes. The purpose of this research is to enforce the entire disease classification framework by supporting disease classification specialists in the coding process.

Methodology: This study developed an ICD code advisory system (ICD-AS) that performed knowledge discovery from discharge summaries and suggested ICD codes.