摘要
目的 分析院内医保合规自查系统对“除外内容”收费的合规性和合理性审核及成效。方法 对比2021年1—6月和2022年1—6月两个时间段,系统运行前、后的“除外内容”的违规收费记录。结果 系统运行之前,“除外内容”的违规例数高达12707例,涉及金额545766元;系统运行之后“除外内容”的违规例数下降至1462例,下降幅度达88.49%,涉及金额减少至98228元,减少幅度达82.00%。“除外内容”的违规项目构成比也发生了变化。结论 院内医保合规自查系统能够有效降低“除外内容”收费的违规例数和违规金额,成效显著。
Objective To analyze the compliance and rationality audit and effect of"excluded content"charges by in-hospital medical insurance compliance self-examination system.Methods The illegal charging records of"excluded content"before and after the system operation were compared between January-June 2021 and January-June 2022.Results Before the operation of the system,the number of illegal cases of"excluded content"was as high as 12,707,involving an amount of 545,766 yuan;After the operation of the system,the number of illegal cases of"excluded content"dropped to 1,462,with a decrease of 88.49%,and the amount involved decreased to 98,228 yuan,with a decrease of 82.00%.The proportion of illegal items in"excluded content"has also changed.Conclusion The self-examination system of in-hospital medical insurance compliance can effectively reduce the number and amount of violations of"excluded content"charges,and the effect is remarkable.
作者
翁燕榕
李秋艳
WENG Yan-rong;LI Qiu-yan(Fujian Provincial Hospital)
出处
《医院管理论坛》
2023年第1期82-85,共4页
Hospital Management Forum
关键词
医保
合规自查系统
除外内容
违规
Medical insurance
Compliance self-examination system
Excluded content
Violations of rules
