社保病种分类核查方法探讨

Exploring the Checking Method of Classification of Social Medicare Disease

目的探讨一种快速准确的社保病种分类核查方法,以确保社保病人的正确付费。方法采用结构化查询语言,每月从病案首页数据库中筛选出全部特殊病种的病人,并与该月社保住院病人住院费用月结统计表进行比较,发现有误者再进一步做人工核查。结果在一个工作日内即可完成一个月全部社保病人的病种核查,从而及时纠正错误的病种分类。结论该法可以有效提高病种分类核查的效率,确保社保病人的正确付费。

Objective To explore a quick and accurate checking method of classification of social medicare disease, so as to insure the social medicare patients pay rightly. Method With the Structural Query Language, all the Social Medicare patient data were selected from the database of the First page of medical files every, month, and the selected data was compared with the settlement table of the Social Medicare inpatients of the same month, if any error exits, it was checked by manual work. Results All the disease type checking of the Social Medicare patient of a month could be finished within one day, so the misclassification of disease could be corrected in time. Conclusion The method could increase the efficiency of checking of disease type, and could insure the inpatients pay correctly.