总额预付下的医疗保险门诊拒付费用管理

The management of refusing payment of medical insurance in outpatient under global budget

随着医疗保险患者范围的不断扩大,医疗保险经办机构加大了对医疗机构合理使用医疗保险基金的管理力度,对违反医保政策的门诊费用予以拒付。作为总额预付改革及"医药分开"试点单位,为更好地配合医改顺利进行,通过探讨医保费用拒付原因,提出积极应对措施,并对运行过程中取得的成效及出现的问题进行了讨论。

With the expansion of medical insurance coverage in Beijing,the medical insurance management institute strengthens the management of rational use medical insurance funds and refuses to pay illegal outpatient expense.As a pilot hospital of global budget and separated management between drugs and medical service reform and to assuring health system reform smoothly developed,the effect,problems and their causes of refusing payment in outpatient service are analyzed.