医保智能审核功能与医生工作站的集成与应用  

Intergration and Application of Intelligent Audit Function of Medical Insurance Embed in Doctor Station

作　　者：夏慧[1] 张红君[1] 李雪龙[1] 张帆[1] 

机构地区：[1]解放军第161医院,武汉市430010

出　　处：《中国卫生信息管理杂志》2017年第3期466-469,共4页Chinese Journal of Health Informatics and Management

摘　　要：目的根据医保智能审核业务要求,实现基于医生站的医保实时监控与提醒,达到事前提醒,事中干预,事后统计分析的全过程管理。方法对HIS系统的相关程序(门诊医生站、住院医护站、医保收费系统)进行接口改造,集成了医保审核规则实时提醒功能。结果医保智能审核系统与医院信息系统集成后,每月扣减费用逐步递减,有较明显的社会、经济效益。结论通过将医保智能审核系统嵌入门诊医生站和住院医护站,实现了医院对各类医保费用进行全面审核及监控管理,提升了医院信息系统的应用价值。Objective Realize the function based on the real-time monitoring in doctor station according to the requirements for health care audit services, achieve the whole process of management medical doctor to remind, warn in the intervention and statistical analysis afterward. Methods The interfaces of health information system were modified, for example, outpatient doctor station, hospital medical station and medical insurance charging system, integrated health care audit rules real-time alerts. Results The monthly deduction expense decreased gradually after the integration of medical insurance intelligent audit system and hospital information system,, which has obvious social and economic benefits. Conclusion Through the practical application of embedded outpatient station and inpatient medical station, the hospital has realized the comprehensive audit and monitoring management of the medical expenses of various types of medical insurance, and promoted the application value of the hospital information system.

关 键 词：医保智能审核 医生站 接口 

分 类 号：R-39[医药卫生] R192.3