传染病专科医院门诊医保拒付产生的原因及整改措施  

The Reasons and Corrective Measures of Outpatient Medical Insurance Protest in Infectious Disease Hospital

作　　者：付娜[1] 王沛陵[1] 段小宛 

机构地区：[1]首都医科大学附属北京佑安医院医保办,100069

出　　处：《中国卫生标准管理》2015年第17期13-15,共3页China Health Standard Management

摘　　要：目的分析医院门诊医保拒付费用,采取防控措施,完善医院流程管理,规范医疗行为,减少医保拒付费用,使医保总额预付指标执行的更加顺畅。方法统计分析医院近3年门诊医保拒付数据,在加强门诊医保拒付防控管理后,进行门诊医保拒付数据的分析对比。结果医院门诊医保拒付在实施预控管理后,医保拒付现象下降,其它医保门诊控费指标合理增降。结论医保拒付涉及医院医疗多方面的问题,医院多部门应动态对接好医保政策,动态调整医保控费管理,不仅可以降低医保拒付金额,还可以改善其它医保门诊控费指标。Objective To analyze the cost of outpatient medical insurance protest,take prevention and control measures to improve the hospital process management,standardize medical practices,reducing the cost of medical insurance protest,bringing the total amount medical insurance paid index performed more smoothly.MethodsStatistical analysis of outpatient protest in hospital for three years,after strengthening the prevention and control of non-payment medicare outpatient management,analyzed and compared of data of outpatient medical insurance protest.Results After the implementation of the pre-control management,medical insurance protest decreased other medical insurance outpatient indicators reasonable control costs drop by. Conclusion Medical insurance protest involves lots aspects of hospital issues,the hospital should be dynamic docking with health insurance policy,to dynamicaly adjust the medical insurance management control,not only can reduce the amount of health insurance protest,but also improve other outpatient control costs index.

关 键 词：医保政策 拒付管理 门诊费用 

分 类 号：R19[医药卫生—卫生事业管理]