PDCA循环模式在医院医保审核中的运用  

PDCA Cycle Model in Medicare Auditing Process Application

作　　者：李扬[1] 郝晓刚[1] 杨燕[1] 卢福昱[1] 王浩[1] 

机构地区：[1]解放军第三〇二医院医保办,北京100039

出　　处：《中国医疗保险》2013年第10期49-51,共3页China Health Insurance

摘　　要：医保审核是检验医疗机构在医保管理过程中政策宣传、制度实施、环节监控、部门协调、质量把关等一系列制度落实与否的重要手段。审核工作涉及面广,政策性强,审核时间也因此延长,矛盾随之而来。为满足医患双方的便捷需求,我们进一步修订制度、改进流程、加强管理,通过引入PDCA循环模式,实现医院医保审核质量及效率持续提高。Medicare audit is an important measure to test whether the policies, including policy advocacy, system implementation, process control, departmental coordination and quality control, are properly implemented during the medicare operation in medical institutions. The audit could be very complicated and rigid, thus contradiction between the applicant and the manager of the medical insurance may occur as the audit period extended. To meet both the doctors＇ and patients＇ convenient, we revised the system, improved the process, enhanced the management, and realized the improvement of the quality and efficiency of medicare audit by introducing the PDCA cycle model.

关 键 词：PDCA循环模式 医保管理 医保审核 

分 类 号：R197.3[医药卫生—卫生事业管理] F842.6[医药卫生—公共卫生与预防医学]