智能监控系统在医院医保费用控制中的应用效果评价
|
摘要
目的引入医保智能监控系统,将监管延伸到医生端,通过医保智能审核系统对医疗费用单据进行审核,对可疑单据在医生工作站以弹出对话框的形式提醒医生,强化医保对医疗行为的监管,规范医疗服务行为、控制医疗费用不合理增长以促进医保费用的合理使用。方法分析当前医院医保费用管理控制的难点,提出医保智能监控系统通过对医疗服务行为进行事前预警、事中提示、事后强化责任人追溯的模式破解医保费用管理的难点。结果发挥"三位一体"全方位监管,监管项目不合理单据减少,有效减少了不合理费用的产生,医保费用使用日趋合理化。结论完善智能审核系统标准化规则数据库,利用医保智能监控系统有助于规范医生的诊疗行为,医保智能监控数据为医保质量监管者提供强有力的抓手工具,对医保费用尤其是不合理费用的控制具有重要意义。
Objective Through the introduction of intelligent health insurance monitoring system, the supervision was extended to the doctors' end. Intelligent health insurance monitoring system reviewed the medical bills and reminded doctors of questionable medical bills with pop-up notification at doctor workstation, in order to strengthen the supervision of medical service behaviors, to regulate medical services, to control unreasonable growth of medical expenses, and to promote the rational use of health insurance funds. Methods This paper analyzed the difficulties in current management and control of health insurance fund, and suggested to overcome them by intelligent health insurance monitoring system through pre-warning, notification in the interim, and strengthening the traceability of the responsible person afterwards. Results The "three in one" all-round supervision reduced unreasonable medical bills and medical cost, therefore making the use of health insurance funds more rational. Conclusion Improving the standardized database of the intelligent monitoring system and applying intelligent health insurance monitoring system helps regulate doctors' diagnosis and treatment behaviors. The intelligent health insurance monitoring data provides a powerful tool for the health insurance quality supervisors, and is significant to the control of health insurance cost, especially unreasonable cost.
Objective Through the introduction of intelligent health insurance monitoring system, the supervision was extended to the doctors' end. Intelligent health insurance monitoring system reviewed the medical bills and reminded doctors of questionable medical bills with pop-up notification at doctor workstation, in order to strengthen the supervision of medical service behaviors, to regulate medical services, to control unreasonable growth of medical expenses, and to promote the rational use of health insurance funds. Methods This paper analyzed the difficulties in current management and control of health insurance fund, and suggested to overcome them by intelligent health insurance monitoring system through pre-warning, notification in the interim, and strengthening the traceability of the responsible person afterwards. Results The "three in one" all-round supervision reduced unreasonable medical bills and medical cost, therefore making the use of health insurance funds more rational. Conclusion Improving the standardized database of the intelligent monitoring system and applying intelligent health insurance monitoring system helps regulate doctors' diagnosis and treatment behaviors. The intelligent health insurance monitoring data provides a powerful tool for the health insurance quality supervisors, and is significant to the control of health insurance cost, especially unreasonable cost.
引文
1张乐辉,魏永祥,陈方,等.我院应对医保总额预付的管理实践[J].中华医院管理杂志,2014,20(12):910-912.
2 程苏华.智能审核系统在门诊费用管理中的应用[J].医院管理论坛,2016,33(3):19-21.
2 程苏华.智能审核系统在门诊费用管理中的应用[J].医院管理论坛,2016,33(3):19-21.