医保智能化监管系统在医保管理中的应用及分析

Application and Analysis of Medical Insurance Intelligent Supervision System in Medical Insurance Management

随着医疗体制的改革,医疗保险制度的不断完善规范,我国已进入全民医保时代。医保智能化监管系统是提高医保管理水平的重要途径,医疗机构利用信息化管理将整体业务串联成一个信息反馈、问题确认、落实整改、再次反馈的闭环流程,全流程均由智能监控系统处理并留痕,让医保收费、医保结算更加透明化、清晰化,采取事前提示、事中监控、事后审核,在一定程度上规范诊疗行为,保障医保基金的安全使用,提升医保管理工作的质量与效率,提升医院的经济效益和社会地位,促进医院服务质量的整体提高。

With the reform of the medical system and the continuous improvement and standardization of the medical insurance system,my country has entered the era of universal medical insurance.The medical insurance intelligent supervision system is an important way to improve the medical insurance management level.Medical institutions use information management to connect the overall business into a closed-loop process of information feedback,problem confirmation,implementation of rectification,and feedback again.The entire process is processed by the intelligent monitoring system and left traces,making medical insurance charges and medical insurance settlement more transparent and clear.Pre-reminders,monitoring during the event,and review after the event are adopted to standardize the diagnosis and treatment behavior to a certain extent and ensure the safe use of medical insurance funds,improving the quality and efficiency of medical insurance management,improving the economic benefits and social status of hospitals,and promoting the overall improvement of hospital service quality.