门诊退费医保原因分析及防范措施

Cause Analysis on Outpatient Refund of Medical Insurance and the Preventive Measures

门诊退费原因繁多,过程复杂,向来是医院管理的难点。而因医保原因导致的门诊退费往往涉及医保政策、医保信息系统、医院财务制度及各临床科室等部门,管理难度更大。笔者总结分析我院因医保导致的门诊退费,从参保人员、医院管理方面着手,找出退费原因,提出防范对策,以期建立更加规范的管理流程,为参保人员提供更加优质的服务。

The causes and the process of outpatient refund are complex, which have been a difficulty in hospital manage- ment. The management is quite difficult because the refund relates to medical insurance policy, medical insurance information sys- tem,hospital accounting system and all clinical departments. The authors summarize and analyze the outpatient refund in our hospital and find out the causes froln the insured persons and hospital management,and put t＇orward the preventive measures so as to establish more standardized management process and provide the insured persons with service of higher quality.