基于DRGs的医保数据采集上传系统设计与应用

Design and Application of Medical Insurance Data Collection and Upload System Based on DRGs

随着国家医改制度进一步深化,医保支付制度改革全面推进,根据当地医保部门对疾病诊断相关分类(DRGs)点数付费改革的要求,医院作为当地医保机构选中的首批DRGs支付改革试点医院,需利用信息化手段对医保患者的医疗数据进行采集并上传,以便后期医保管理部门按照DRGs点数付费的标准为医院拨付报销费用。我院根据本地医保DRGs数据标化接口规范要求,开发了基于DRGs的医保数据采集上传系统,本文主要对该系统的程序设计、业务流程、功能模块实现及系统应用情况进行总结,以期为部队医院搭建医保DRGs数据接口提供参考。

With the further deepening of the national medical reform system,the reform of the medical insurance payment system is comprehensively advanced.According to the local medical insurance department's requirements for the reform of diagnosis-related classification(DRGs)point payment,as the first batch of DRGs payment reform pilot hospitals selected by local medical insurance institutions,the hospital needs to use information technology to collect and upload medical data of medical insurance patients,so that the medical insurance management department can allocate reimbursement expenses for the hospital in accordance with the DRGs point payment standard.Our hospital developed a medical insurance data collection and upload system based on DRGs according to the requirements of local medical insurance DRGs data standardization interface.This article mainly summarizes the program design,business process,functional module realization and system application of the system,in order to provide a reference for military hospitals to build medical insurance DRGs data interface.