Abstract

In this paper we describe a solution based on a permissioned blockchain to facilitate the auditing of tw-DRG inpatients’ claims so that the DRG creep cases can be decreased. Two smart contracts will be designed to cover
scenarios in tw-DRG inpatients’ claim process and be deployed on the permissioned blockchain, they are the Patient-Provider Service Contract (PPS) and the Coder Classification Contract (CCC), respectively. The PPS would log
all the medical services provided by healthcare providers with the providers’ encrypted signatures during an inpatient’s stay in a hospital. The CCC will audit the coder’s tw-DRG
classification based on an artificial intelligent (AI) system. Once approved by the AI system, the coder submits the tw-DRG classification and his/her encrypted signature to the blockchain’s
distributed ledger so the insurer can share all the information that is required to audit the inpatient’s claim. By leveraging the distributed, irreversible, and incorruptible nature of a blockchain, it is hoped that a platform where
tw-DRG inpatient’s claims can be audited more effectively to reduce the DRG creep cases is developed.
Original languageEnglish
Pages (from-to)1-10
Journalinternational journal of scientific engineering and applied science
Publication statusPublished - Feb 2017

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