全面质量管理在医保病案编码填写中的应用价值  

Application Value of Total Quality Management in Medical Insurance Medical Record Coding

作　　者：李霞[1] 高文法[2] LI Xia;GAO Wenfa(Department of Medical Records,Puyang Oilfield General Hospital,Puyang,Henan Province,457001 China;Legal Affairs Office,Puyang Oilfield General Hospital,Puyang,Henan Province,457001 China)

机构地区：[1]濮阳市油田总医院病案科,河南濮阳457001 [2]濮阳市油田总医院法律事务办公室,河南濮阳457001

出　　处：《中国卫生产业》2022年第17期1-4,共4页China Health Industry

摘　　要：目的探讨全面质量管理在医保病案编码填写中的实践应用价值。方法随机选取2021年2月—2022年2月于濮阳市油田总医院住院的400例参与市级或省级职工医疗保险患者的病案资料为研究对象。病案资料实施全面质量管理者为观察组(200例),实施常规医保病案编码管理者为对照组(200例),比较两组医保病案编码准确情况,统计两组干预后医院医疗保险管理科对临床医师的医保管理质量评分、上级管理部门对医院的医保管理质量评分,以及两组住院患者医保费用结余情况。结果观察组医保病案编码准确无误的比例显著高于对照组,差异有统计学意义(P<0.05)。观察组干预后医院医疗保险管理科对临床医师的医保管理质量评分和上级管理部门对医院的医保管理质量评分均显著高于对照组,差异有统计学意义(P<0.05)。观察组普通住院患者医保费用结余金额显著高于对照组,急危重症住院患者超支金额显著少于对照组,差异有统计学意义(P<0.05)。干预后观察组病案质量整体得分高于对照组,差异有统计学意义(P<0.05)。结论针对医保病案编码填写进行全面质量管理,可有效提高医保病案编码填写的准确率,提高医保管理效率,降低医保费用支出,提高病案书写质量.Objective To explore the practical application value of total quality management in medical insurance medical record coding.Methods The medical records of 400 patients with municipal or provincial employee medical insurance who were hospitalized in Puyang Oilfield General Hospital from February 2021 to February 2022 were randomly selected as the research objects.The implementation of total quality managers was the observation group(200 cases),and the implementation of routine medical insurance medical record coding managers was the control group(200 cases).The accuracy of medical record coding in the two groups was compared,and the medical insurance management quality scores of the hospital medical insurance management department for clinicians,the medical insurance management quality scores for the hospital by the superior management department,and the balance of medical insurance expenses for inpatients in the two groups after the intervention were calculated.Results The proportion of medical insurance medical records coding in the observation group was significantly higher than that in the control group,and the difference was statistically significant(P<0.05).After the intervention,the hospital medical insurance management department's medical insurance management quality score for clinicians and the superior management department's hospital medical insurance management quality score were significantly higher than those in the control group,and the difference was statistically significant(P<0.05).The balance of medical insurance expenses for ordinary inpatients in the observation group was significantly higher than that in the control group,and the overspending amount for acute and critically ill inpatients was significantly lower than that in thcontrol group, and the difference was statistically significant (P<0.05). After intervention, the overall score of medical record quality in the observation group was higher than that in the control group, and the difference was statistically significant (P<0.05). Conc

关 键 词：全面质量管理 病案编码 医疗保险 

分 类 号：R197.323[医药卫生—卫生事业管理]