某大型综合医院医保医用耗材编码贯标实践与探索

Practice and exploration of implementing medical insurance code of medical consumables in a large general hospital

目的:确保大型综合医院医保医用耗材编码贯标准确率、提高医用耗材编码贯标比例、提升贯标工作效率。方法:落实医保医用耗材编码贯彻执行工作,回顾医保医用耗材编码贯标过程,总结问题及对策。结果:案例医院贯标匹配国家医保医用耗材编码正确率大于99%,完成率89.67%。针对发现问题和应对过程,提出3个层次的建议。结论:贯标工作应逐一匹配医保医用耗材编码并进行二次核对,宜适当增加贯标工作小组人数;同一品规耗材对应多个医保医用耗材编码时应分辨情况制定应对措施;完善贯标后工作长效机制。

Objective:to ensure the accuracy of medical consumables coding in large general hospitals,improve the proportion of medical consumables coding and improve the efficiency of standard implementation.Methods:implement the coding of medical consumables for medical insurance,review the process of implementing the coding of medical consumables for medical insurance,and summarize the problems encountered and countermeasures.Results:the coding accuracy rate of medical consumables matching the national medical insurance was more than 99%,and the completion rate was 89.67%.For the problem discovery and response process,three levels of suggestions are put forward.Conclusion:the number of medical consumables should be matched one by one and checked twice in the implementation of the standard,and the number of the implementation team should be appropriately increased;Develop countermeasures for the identification of multiple medical insurance medical consumables codes corresponding to the same product specification consumables;And improve the long-term mechanism after the implementation of the standard.