医保定点医院上传ICD编码存在的问题及对策  

The Problems Existing in the Uploading of the ICD Coding in Medical Insurance Designated Hospitals and Countermeasures

作　　者：徐长妍[1] 林红[1] 苏军燕[1] 孙晓萍[1] 

机构地区：[1]吉林大学第一医院,长春市130021

出　　处：《中国病案》2013年第8期67-68,共2页Chinese Medical Record

基　　金：吉林省卫生厅科研课题资助项目(编号:2010R003)

摘　　要：随着医疗保险制度的不断完善,病种费用管理将在医保管理中发挥重要的作用。国际疾病分类编码是医保部门付费的基础和依据。医保定点医院和医保中心采用统一的ICD编码数据库,是保证医保病种编码上传质量的基础和关键。定点医院应重视医保上传编码工作,保证上传编码的质量。同时,医保部门应充分发挥自身的监督和指导作用,保证上传编码的准确性。只有医院和医保部门共同努力,才能有效控制医疗费用和医保基金的支出,保证患者、医院和医保机构三方利益,更好地为参保人员提供高质量的服务。With the improvement of medical insurance, the medical expenditure management will play an important role in health care management. International disease classification coding is the foundation and basis of the payment of health sectors. The employment of the unified ICD code database by the medical insurance designated hospitals and the health centers is the basis and keys to ensure the quality of health insurance disease species codes uploaded. The designated hospitals Should pay more attention to the up- loading of the health insurance codes and ensure the quality of the uploading. At the same time, the health departments should give full play to the supervisory and guiding role to ensure the accuracy of the uploaded codes. Only when the hospital and medical insur- ance departments work together, the medical expenses and medical insurance fund expenditures would be effectively controlled, and the three parties interests of the hospitals, health care institutions, and the patients would be ensured, then will provide high quality service for the insured people better.

关 键 词：ICD编码 医疗保险 医保付费 

分 类 号：R197.3[医药卫生—卫生事业管理]