使用原始病案审核医疗保险费用弊端初探  

Initial Exploration of Disadvantage of Verifying Medical Insurance Charge by Original Medical Records

作　　者：杨雅秋 梁玉涛[2] 岳淑英[3] 

机构地区：[1]河南省平顶山煤业公司医疗集团总医院病案室 [2]山东省泰安卫生学校 [3]北京协和医院病案科

出　　处：《中国病案》2009年第12期12-13,共2页Chinese Medical Record

摘　　要：医疗保险机构使用原始病案审核医疗保险费用是唯一的方法,所存在的弊端也逐渐暴露出来:病案使用频率高,存在诸多不安全因素;病案使用量大,归档容易出差错;患者信息容易外泄;病案使用周期长,影响临床医疗、科研和患者本人使用。建议:加强对医疗保险使用病案的管理,严格把好病案借阅关;要求临床医师规范书写病案;在实际工作中积极做好与上级医保部门的沟通协调工作,让医保管理部门了解医院;教育临床医师不做多余的检查和治疗,不开大处方,合理用药。逐渐使医疗保险机构相信医院,改为抽查审核或使用病案复印件审核医疗保险费用,还可以通过医院网络实现医疗保险费用审核或自查。It is a unique way for medical insurance agencies to verify medical insurance charge by original medical records.Existed disadvantages gradually emerge,including： high-frequency use of medical records with unsafe factors;file placing mistake;the leak of patient＇s information;long-time use of medical records which influencing the use of clinical medicine,research and patients themselves.Thus,suggestions are as follows： improving the medical records management of medical insurance in use and establishing a strict standard on borrowing medical records;requiring clinician to write standardized medical records;communicating and coordinating well with the superior medical insurance department to make them familiar with the hospital;educating clinicians not to do additional examinations and therapies with small prescription and rational administration.Hospitals should be gradually believed by medical insurance agencies which may verify the medical insurance charge randomly by medical records duplications or through hospital network.

关 键 词：医疗保险 病案 审核 

分 类 号：F842.6[经济管理—保险]