浅谈社保医疗服务项目分类与代码在医用耗材管理中的应用——以宁夏回族自治区为例

Talking about Classification and Code of Social Insurance Medical Service Projects Application in Medical Consumables Management

宁夏针对医保监控中发现的医用耗材违规案例发生的深层次原因,于2017年下半年起,在学习兄弟省市先进管理经验的基础上,确定了"参照国标建库、编码准入管理、分类差异支付、搭建信息平台、定期部门联动、适应医学技术发展"的基本医疗保险对医用耗材实施规范管理思路;以同年颁布的《社会保险医疗服务项目分类与代码》为准则,初步建立起医院、物价、医保等部门共同使用的全区统一的医用耗材数据库。本文将具体的工作步骤及经验做交流分享,希望能为医用耗材精细化管理提供参考。

Aiming at the deep-seated causes of medical consumables violations found in medical insurance surveillance in Ningxia, starting from the second half of 2017, on the basis of learning the advanced management experience of other provinces and cities, the management ideas of medical consumables for basic medical insurance were determined. According to the ＂Classiff cation and Code of Social Insurance Medical Service Items＂ promulgated in the same year, a unified regional medical equipment database was initially established for hospitals, prices, medical insurance and other departments. In this paper, the speciff c work steps and experience will be exchanged and shared, hoping to provide a reference for the ff ne management of medical insurance.