【摘要】 目的:分析医院门诊医保拒付费用,采取防控措施,完善医院流程管理,规范医疗行为,减少医保拒付费用。方法:统计分析医院近3年门诊医保拒付数据,在加强门诊医保拒付防控管理后,进行门诊医保拒付数据的分析对比。结果:医院门诊医保拒付在实施预控管理后,医保拒付明显下降,其它医保门诊控费指标合理增降。结论:医保拒付涉及医院医疗多方面的问题,医院多部门应动态对接好医保政策,动态调整医保控费管理,不仅可以降低医保拒付金额,还可以改善其它医保门诊控费指标。更多还原

【Abstract】 Objective: To analyze the outpatient cost medical insurance refusing to pay, carry out measures and improve hospital process management and regulate hospital behavior to reduce protest cost. Methods: Data about protest cost of outpatient in recent 3 years were analyzed. The results before and after implementing management measures were compared. Results: After implementing management measures,the protest cost of outpatient has been significantly decreased and other indictors of medical insurance management is rationally increased or decreased Conclusions: Medical insurance funds refusing to pay related to multi-aspects of problems in hospital management. Multidepartments in hospital should coordinate with medical insurance policy and dynamically adjust medical insurance cost control. It can not only reduce the amount of health insurance protests, but also improve control of other medical insurance management indictors.更多还原