摘要
医保费用计算机审核管理是目前医保审核部门应对海量医疗机构医保费用审核的有效措施之一。绍兴市的"阳光医保"计算机审核管理存在制度顶层设计不够合理、未实行区域统筹、审核范围有限,医院应对机审的内部管理不够到位、管理较为粗放、医务人员认识上存在偏差等问题。应该优化计算机审核管理,建立"事前、事中、事后"的计算机审核机制,提升医院医保管理水平,形成医保、医院双重医保质量管控。
Medical insurance cost computer audit management is one of the effective measures to deal with the cun＇ent medical insurance audit departments massive medical insurance cost. There are some problems of ＂sunshine insurance＂ computer audit management system in Shaoxing City such as the top design is not reasonable, it does not implement regional co-ordination, the audit content is limited and management is not in place and more extensive, the medical staff＇s awareness exists deviation when the hospital is dealing with computer audit, etc. We should optimize the computer audit management, establish a ＂before, during, after＂ computer audit, improve hospital medical insurance management, format dual medical insurance quality control of medical insurance and hospital.
出处
《医学与社会》
2016年第12期55-58,共4页
Medicine and Society
关键词
阳光医保
计算机审核
绍兴
Sunshine Insurance
Computer Audit
Shaoxing
