门诊患者医保实时结算拒付原因分析及对策

Causes of medical insurance payment refusal in real time settlement of accounts in outpatient clinics

目的自北京市医保中心实施门诊实时报销结算以来,我院被拒付的医疗保险统筹金随之增加。为保障医保患者正当的权益,减少医保拒付率的发生,本文针对医保拒付的原因进行分析,并提出相应的改进措施。

Objective Since Beijing Medical Insurance Center began to settle accounts in real time in outpatient clinics,refusal of payment by fund of medical insurance increased markedly in this hospital.To safeguard the legal right and interests of the insured patients and reduce the incidence of refusal of payment,we analyzed the causes of medical insurance payment refusal and devised appropriate countermeasures.