【摘要】 为了充分发挥护士长在医保工作中的管理能力,应做好以下几方面工作,即:把好入院关卡,对患者的身份证件、医保本和医保卡进行核实,保证人、卡、证完全一致。把好审核关卡。防止因审核不过关而出现患者拒付药疗费用的情况。把好宣教关卡,让所有患者都能够明确医保政策的主要内容,避免出现不必要的医疗纠纷。把好监督关卡,根据患者的具体情况认真履行医保服务协议,做好患者权益的保护工作。把好质量关卡,对病例中的各种数据和费用明细进行认真核对和检查,防止出现医保拒付的情况。把好指标关卡,将各种动态信息全部纳入到指标数据管理中来,对各项数据和信息进行合理收集。护士长在医保管理中的作用主要有以下几方面,即随时随地向患者解答关于医保计费的各种问题,保持耐心的工作态度,减少患者的不良情绪。对不同科室中的医保费用、非医保费用和药品比例进行比对和分析,找出医疗费用高的真实原因。对参保人员的住院费用进行审核和管理,丰富医保结算形式。更多还原

【Abstract】 In order to give full play to head nurses’ management ability in medical insurance work,the following aspects should be done well,that is,to make good admission checkpoints. To verify patient’s identity card,medical insurance cost and medical insurance card,the guarantor,card and certificate are identical. Prevent patients from refusing to pay for medical treatment due to the failure of the audit. Let all patients be able to clarify main content of health insurance policy and avoid unnecessary medical disputes. Take good care of the supervisory checkpoint. Carefully implement medical insurance service agreement according to specific conditions of patients,and do a good job in protecting the rights and interests of patients. Make good quality checkpoints. Carefully check of all kinds of data and details of expenses in cases to prevent the occurrence of refusal of medical insurance payment. Make good use of the indicators. All kinds of dynamic information are integrated into index data management,and all kinds of data and information are collected reasonably. The role of head nurses in medical insurance management mainly includes following aspects: answering all kinds of questions about medical insurance billing to patients at any time and anywhere,maintaining a patient working attitude,and reducing patients’ bad mood. Compare and analyze the medical insurance cost,non-medical insurance cost and drug proportion in different departments,and find out real reason for high medical cost. Audit and manage hospitalization expenses of insured personnel,and enrich forms of medical insurance settlement.更多还原