总额预付制下天津市公立医院医保费用对账工作探讨

Discussion on Reconciliation of Medical Insurance Payment in Public Hospitals of Tianjin Based on Total Medical Prepayment

针对公立医院医保费用对账工作量及难度大的问题,提出一套制度化、规范化的对账管理流程。文章选取天津市为研究对象,从医院和医疗保险经办机构两方面着手,分析医保对账工作中存在的问题及原因,提出了一套以医保欠款、会计核算为基础,以医保结算信息化建设为支撑,以医保对账工作流程为核心的医保对账管理工作体系,可以解决医保费用对账问题,提高医院对医保债权的安全性与完整性。

To deal with the Current large workload and difficulty of reconciliation for medical insurance expenses in public hospitals, it proposed a institutionalized and normalized reeonciliation management process. Tianjin was selected as the object of research. Based on hospital and medical insurance institutions, it analyzed the existing problems and reasons of medical insurance on reconciliation, it proposed a medical insuranee debt accounting based, medical settlement information establishment supported, medical insur： ance reconciliation process centered medical insurance reconciliation management work System to solve the problem of medical inSur： ante reconciliation and promote the safety and integrity of the obligatory right for medical insurance.