Application of a single sampling plan for auditing medical-claim payments made by Taiwan National Health Insurance

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Title:	Application of a single sampling plan for auditing medical-claim payments made by Taiwan National Health Insurance
Authors:	Fu, Hwai-hui;Tsai, Hsien-tang;Lin, Ching-wei;Wei, Duan
Contributors:	淡江大學財務金融學系
Keywords:	Sampling audit process;Medical-claim payments;Single sampling plan
Date:	2004-11
Issue Date:	2009-11-30 17:49:51 (UTC+8)
Publisher:	Elsevier
Abstract:	National Health Insurance (NHI) has been implemented in Taiwan for nearly a decade. Owing to growing demand for medical-care, effective sampling auditing is a key factor in obtaining reasonably priced medical-care services. This investigation proposes a conceptual framework “medical-claim payment auditing (MCPA) procedure” based on the “Military Standard 105E (MIL-STD-105E) single sampling plan” for establishing an objective criterion for making medical-claim payments fairly. The MCPA procedure contributes to the following: (1) meeting international standards of sampling technology; (2) reducing the sampling ratio and consequently auditing costs; and (3) encouraging healthcare providers to honestly apply their medical-claim payments thus avoid wasting medical resources.
Relation:	Health policy 70(2), pp.185-195
DOI:	10.1016/j.healthpol.2004.02.006
Appears in Collections:	[Graduate Institute & Department of Banking and Finance] Journal Article

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