基于前置质控的医保基金结算数据质量改进探讨  

Exploration on the quality improvement of medical insurance fund settlement data based on pre-quality control

作　　者：柳青[1] 张方[1] 苏义武 李汉民[1] Liu Qing;Zhang Fang;Su Yiwu;Li Hanmin(Information Center,Zhongnan Hospital of Wuhan University,Wuhan 430071,Hubei Province,China)

机构地区：[1]武汉大学中南医院信息中心,武汉430071

出　　处：《中国数字医学》2022年第6期104-108,共5页China Digital Medicine

摘　　要：武汉市作为国家首批疾病诊断相关分组(DRG)付费试点城市,率先开展了按医疗保障基金结算清单上报数据的工作,武汉大学中南医院作为武汉市第一批DRG付费试点单位,按照武汉市医保局的时限要求完成了院内HIS系统与医保结算系统对接及改造工作,同时在持续进行医保结算清单上传过程中,引入了前置质控,医保结算清单上传成功比例及数据质量得到明显提升。As one of the first batch of diagnosis-related group(DRG)paid pilot cities in China,Wuhan has carried out the report data work according to the medical insurance fund settlement list.As one of the first batch of pilot units of DRG payment in Wuhan,our hospital completed the hospital's HIS system and medical insurance settlement system connection and reconstruction work with the time limit requirement of Wuhan Medical Insurance Bureau.At the same time,pre-quality control is introduced in the process of continuous uploading of the medical insurance settlement lists,which improved the successful uploading rate and data quality of medical insurance settlement list significantly.

关 键 词：医疗保障基金结算清单 质量控制 病案首页 数据质量 

分 类 号：R319[医药卫生—基础医学]