2015年某医院医保结算抽样审核问题数据分析

Data Analysis on Sampling Audit of Medical Insurance Settlement in A Hospital in 2015

目的通过分析某医院医保审核中发现的问题并加以整改,从而减少医保中心拒付医疗费用的现象。方法回顾性分析2015年医保结算抽样审核中问题数据,找出存在的问题,制定相应措施。结果问题数据清单143份,药品方面问题96条,占问题数据67.13%;收费方面问题20条,占问题数据13.98%;检查方面问题27条,占问题数据18.89%。结论通过加强内部管理,规范医保使用范围。

Objective Through the analysis of a hospital health problems found during the audit and improvement, thus reducing health care center refuse to pay medical fees. Methods A retrospective analysis of the year of 2015 medical insurance settlement problem in sampling audit data, find out problems, formulate corresponding measures. Results Problem data list of 143, the drug issues 96, the problem data was 67.13%. Charging problems article 20, the problem data was 13.98%. Check the problems of article 27, the problem data was 18.89%. Conclusion By strengthening internal management, standardize the use of medical insurance.