某保险公司在医保病历审核中发现的问题研究

Research on the Problems Found in Medical Record Review of the Medical Insurance in an Insurance Company

本文研究某商业保险公司在对医疗费用清单审核过程中发现的问题,并从医保部门、商业保险公司以及医疗机构三方提出相应改进意见,加强对医疗行为进行监督,控制医保基金的支出。

This paper studied problems found by a business insurance company in the process of the medical expenses list audit, and from the three parties of the medical insurance department, business insurance company and medical organization, put forward the corresponding improvement suggestions, to strengthen the supervision of medical behavior and control the medical insurance fund expenditures.