浙江省DRG付费病例反馈申述与相关问题探讨  

Discussion on Feedback and Related Issues of DRG Paid Cases in Zhejiang Province

作　　者：周仲炜 吕晨曦 ZHOU Zhong-wei;LV Chen-xi(Tongde Hospital of Zhejiang Province)

机构地区：[1]浙江省立同德医院

出　　处：《医院管理论坛》2023年第9期19-21,34,共4页Hospital Management Forum

摘　　要：浙江省医保局实施DRG支付方式改革以来,通过大数据监测和智能审核系统,建立立体式病案监管体系,对医院病案质量管理提出了更高要求。文章通过对DRG点数法付费政策及病例类型的介绍,重点阐述DRG病例审核反馈流程,包含病例分组反馈、特病单议及15天再入院反馈申诉存在的问题。探讨通过加强医保政策学习、规范病案管理等措施提高病例审核反馈质量,保障医院获得医保合理支付。Since the implementation of the DRG payment method reform,Medical Insurance Bureau of Zhejiang Province has established a three-dimensional medical record supervision system through big data monitoring and intelligent audit system,which puts forward higher requirements for the quality management of hospital medical records.Through the introduction of DRG point payment policy and case types,the paper focuses on the DRG case review feedback process,including the problems of case group feedback,individual discussion of special disease and 15-day readmission feedback appeal.Through strengthening the study of medical insurance policy and standardizing medical record management,improve the quality of case review feedback so as to ensure the reasonable payment of medical insurance for hospitals.

关 键 词：病案管理 病例审核反馈 DRG点数法付费 疾病编码 

分 类 号：R197.3[医药卫生—卫生事业管理]