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医保单病种审核流程的探讨

Exploration of Medical single disease auditing procedure

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【作者】 詹新徽彭云红

【Author】 ZHAN Xin-hui;PENG Yun-hong;Department of Medical Insurance,the First Affiliated Hospital of Shihezi University School of Medicine;

【机构】 石河子大学医学院第一附属医院医保办

【摘要】 社会基本医疗保险的支付方式是医疗保险过程中涉及医疗保险各方面经济利益的最直接、最敏感的环节,是医疗保险制度的重要组成部分。石河子社保局所支付单病种费用是由医院审核申报的,社保局负责对医院进行考核。单病种的申报对医院的信誉及经济利益起着重要的作用,因此正确审核并申报单病种成为医院医保办工作的重点。笔者在本文重点介绍单病种的审核流程。

【Abstract】 Social basic medical insurance payment are the most direct and most sensitive part of medical insurance in all aspects of economic interests in the health insurance process. It is an important part of the medical insurance system.Shihezi Bureau of social security pay the costs of single disease is examined and declared by the Hospital. The Bureau of social security response for hospitals assessment. The hospital’s reputation and economic interests plays an important role in the declaration of single disease,so the correct examination and declaration disease to become the focus of the hospital health insurance to do the work. The author focuses on a single disease of the audit process in this article.

  • 【文献出处】 农垦医学 ,Journal of Nongken Medicine , 编辑部邮箱 ,2013年05期
  • 【分类号】R197.3
  • 【被引频次】1
  • 【下载频次】48
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