定点医院预防医保拒付的对策思考

Countermeasures for the Medicare Repudiation in the Designated Hospitals

定点医院在与医保经办机构结算医疗费用时,部分费用被拒付的现象时有发生。尽管原因诸多,但从医院方面看,预防拒付的根本之道在于加强管理,严格履行医疗保险医疗服务协议,准确贯彻执行医保政策和管理规定,完善内部监督检查和考核奖惩机制,建设医院与医保互联互通的信息系统等;医保与医院要建立平等原则下的协商谈判机制,签订互利共赢的医疗服务协议。

The cases that partial expenses were repudiated constantly happen when the designated hospitals settle the medical expense with health insurance agencies. Despite the complex factors for this problem, it is essential for the hospital to prevent the repudiation by strengthening the management, carrying out the health insurance service protocol strictly, impelling the health insurance policy and management discipline precisely, perfecting the internal self-regulation and rewards ＆ punishment mechanism, establishing the information system between hospital and health insurance agency. The hospitals should create a negotiation mechanism with the health insurance agencies under the principle of equality, and sign a medical service protocol that has mutual benefit.