门诊医保拒付管理缺陷及应对措施  

Management defi ciencies of refusing payment of medical insurance in out-patient department and its countermeasures

作　　者：贺涛[1] 王昆[1] 武娜[1] 史洪飞[2] 邱明辉[2] 刘静[1] 侯莹[1] 

机构地区：[1]解放军总医院医疗处,北京1008531 [2]解放军总医院医学信息情报所,北京1008531

出　　处：《解放军医学院学报》2014年第11期1178-1180,F0003,共4页Academic Journal of Chinese PLA Medical School

基　　金：国家"863"计划项目(2012AA02A612);解放军总医院临床扶持基金(2012FC-ZHCG-1001)~~

摘　　要：自门诊实施医保持卡实时结算以来,门诊拒付已成为我院医保付费的主要问题。为减少门诊拒付,我们分析了2011年1月-2013年12月门诊医保拒付数据,找出原因,提出整改措施。Since the implementation of holding the Social Security card to settle accounts in out-patient department,the refusing payment of medical insurance has become the main reason for non-payment.The data of refusing payment of medical insurance in out-patient department from January 2008 to December 2013 is analyzed in this study,in order to reduce the condition of refusing payment,find management deficiencies of medical insurance in outpatient,and propose the corresponding corrective measures.

关 键 词：医疗保险 医院管理 门诊医疗 

分 类 号：R197[医药卫生—卫生事业管理]