Publication Date
Fall 2025
Course Name
Experiential Learning for Choose Ohio First Scholars
Course Number
N/A (Currently PF 500)
Subject
Professional Foundations
Abstract
This project investigates the use of the Pneumonia Severity Index (PSI) in conjunction with administrative claims data to improve the identification of inappropriate principal diagnoses for inpatient claims classified as DRG 193 (Simple Pneumonia & Pleurisy with MCC). By mapping PSI clinical factors to UB-04 claim form elements and ICD-10-CM codes, a predictive model was developed and tested on 2,038 claims. The model demonstrated a 46% accuracy rate in identifying claims with audit findings, suggesting that integrating clinical decision tools like PSI can enhance audit efficiency and reduce unnecessary claim reviews. Limitations include reliance on proxy data and restricted access to clinical information. Future work will explore broader clinical decision support tools and refine diagnostic criteria for model expansion. [Abstract generated by AI.]
Recommended Citation
Moore, Susan, "PSI Pneumonia Project" (2025). Distinguished Student Scholarship Collection. 9.
https://fuse.franklin.edu/dssc/9
