规范物价收费管理在降低医保拒付中的应用

Application of regulating price charge management in reducing medical insurance protest

目的规范物价收费管理,降低因医疗服务项目收费因素造成的医保拒付额。方法运用PDCA管理工具,分析医保拒付原因中医疗服务项目收费因素,持续改进物价管理,形成固化的规范收费流程。结果整改前(2015年)与整改后(2016年)相比,医疗服务项目收费因素医保拒付病历例次、金额均有明显下降。结论完善制度、合理培训、加强费用核查、严格考核等一系列物价收费管理的规范,有利于降低医保拒付额。

Objective To standardize the management of price charge and reduce the amount of medical insurance refusal caused by the charging factors of medical service items. Methods Using PDCA management tools, the reasons for the medical service charges in the cause of medical insurance protest were analyzed to improve price management continuously and to form a consolidated standard charging process. Results Before the rectification （2015） and after the rectification （2016）, medical insurance fees, medical insnrance protest cases, the amount of money has declined significantly. Conclusion A series of price charge management regulations, such as perfecting the system, reasonable training, strengthening cost verification and strict examination, are conducive to reducing the amount of medical insurance refusal.