吉安市医保智能监控建设实践  

Practice of Promoting the Medical Insurance Intelligent Monitoring Construction in Ji'an City

作　　者：管萍 刘宇刚 刘勇 Guan Ping;Liu Yugang;Liu Yong(Ji'an Healthcare Security Bureau,Ji'an,343000)

机构地区：[1]吉安市医疗保障局,吉安343000

出　　处：《中国医疗保险》2021年第12期55-58,共4页China Health Insurance

摘　　要：吉安市推进医保智能监控建设中,坚持实时性、真实性和精准性目标,建成了涵盖19个功能子系统的医保智能监控平台。通过“组合拳”出招方式,有效破解平台落地运用上的各大难题,在提升医保结算单据审核质效、遏制医保基金支出过快增长及促进医药机构主动强化内部管理和规范诊疗行为上取得一定成效。Ji'an City adheres to the goals of real-time,authenticity and accuracy in promoting the construction of medical insurance intelligent monitoring,and has built a medical insurance intelligent monitoring platform covering 19 functional subsystems.Through various ways,Ji'an City has effectively solved the major problems in the landing and application of the platform.Some achievements have been made in improving the quality and effi ciency of medical insurance settlement document audit,curbing the excessive growth of medical insurance fund expenditure,and promoting medical institutions to actively strengthen internal management and standardize diagnosis and treatment behavior.

关 键 词：智能监控 单据审核 数据质量 

分 类 号：F840.684[经济管理—保险] C913.7[社会学]