医院医疗保险费用拒付原因分析及解决办法

The Reason Analysis and Solution of Refusal to Pay Medical Insurance Expenses in Hospital

目的:降低医疗保险拒付,减少医院的经济损失。方法:通过分析2013年-2015年医保拒付数据,分析拒付原因,找到解决办法。结果:通过规范医疗行为,加大信息系统支持,加强与医保经办部门沟通,提高医务人员对医保政策内涵理解是减少拒付的可能解决办法。结论:在医保总额预付方式下,医疗保险拒付管理越来越重要,从事医疗保险管理工作不光要深入掌握医保政策,还应该学习包括临床医学、护理、医疗设备、信息等各种知识,探索新的管理办法,降低拒付费用。

Objective To decrease the refusal to pay for the medical insurance, and reduce the economic losses of the hospitals. Methods： Through the analysis on the data about refusal to pay for the medicine insurance from 2013 to 2015, the refusal reasons are analyzed and a solution is found. Results： By regulating medical behaviors, increasing the information system support, the strengthening the communication with the medical insurance department, and improving the medical staffs＇ understanding of connotation of medical insurance policy is the possible solution to reduction the refusal of payment. Conclusion： With the method of the advance payment of the total amount of medical insurance, the management of refusal to pay for the medical insurance has become more and more important. People engaged in the medical insurance management should not only deeply grasp the medical insurance policy, but also study various knowledge, including clinical medicine, nursing, medical equipment and information. By exploring the new management approaches. The refusal of payment can be managed well, and the expenses refused to pay can be reduced.