异地医保快速直接结算系统的构建  

Construction of a rapid and direct settlement system for out-of-town medical insurance

作　　者：但秀娟 皇甫明放 史洁 张伟 DAN Xiujuan;HUANGFU Mingfang;SHI Jie;ZHANG Wei(Section of Medical Economy Management,the Fourth Medical Center,Chinese PLA General Hospital,Beijing 100048,China;Department of Medical Service,the Fourth Medical Center,Chinese PLA General Hospital,Beijing 100048,China;Department of Medical Service,the Sixth Medical Center,Chinese PLA General Hospital,Beijing 100048,China)

机构地区：[1]中国人民解放军总医院第四医学中心卫生经济管理科,北京100048 [2]中国人民解放军总医院第四医学中心卫勤部,北京100048 [3]中国人民解放军总医院第六医学中心卫勤部,北京100048

出　　处：《转化医学杂志》2020年第3期165-168,共4页Translational Medicine Journal

基　　金：军队医学科研项目(CWS11R297)。

摘　　要：目的构建完善医院异地医保快速直接结算服务系统,最大限度提高异地患者当日结算率。方法分析影响医院异地医保当日结算率的主要原因,在信息化和组织管理两个层面构建全方位多维度的异地医保直接结算服务系统。结果组织管理和信息化管理两个层面的有机结合,形成了完整的闭合管理链条,使当日结算率大幅提高。结论两个层面相互补充,缺一不可,共同构成完善高效的结算管理系统,最大程度满足了异地医保患者的快速直接结算需求,减少当日结算差错率。Objective To establish and improve a rapid and direct settlement service system for out-of-town medical insurance,and maximize the same-day settlement rate for out-patients.Methods To construct a comprehensive and multi-dimensional remote medical insurance direct settlement service system at the two levels of informationization and organization management.Results The organic combination of organizational management and informationization management forms a complete closed management chain,which greatly improves the settlement rate.Conclusion The two levels complement each other and are indispensable.Together,they form a complete and efficient settlement management system,which meets the needs of rapid and direct settlement of medical insurance patients to a large extent and reduces the settlement error rate.

关 键 词：医疗保险 异地结算 管理系统 

分 类 号：R197.32[医药卫生—卫生事业管理]