提升医疗保险结算数据质量的路径探析

Analysis on Path to Improve Quality of Medical Insurance Settlement Data

目的提高CHS-DRG(国家医疗保障疾病诊断相关分组)支付的医疗保险结算数据质量。方法实施干预措施:(1)DRG事中管理系统嵌入电子病历系统,用于结算后分析。(2)建立医保结算清单审核系统用于结算。(3)明确病案首页、医保结算清单填写规范,开展CHS-DRG相关培训。运用SPSS26.0统计分析数据。结果干预后22个科室入组率提高,其中8个科室入组率显著提高。结论建立DRG智慧管理系统,开展多部门协同合作,有利于提高医保结算数据质量,助力医院精细化管理。

Objective To improve the quality of medical insurance settlement data paid by China Healthcare Security Diagnosis Related Groups(CHS-DRG).Methods Implementation of intervention measures:(1)Embedment of DRG management system in the electronic medical record system for post-settlement analysis.(2)Establishment of a medical insurance settlement checklist review system for settlement.(3)Formulation of specifications for filling in the front page of medical records and medical insurance settlement list,and carrying out CHS-DRG related training.SPSS 26.0 was used to analyze the data.Results After the intervention,the enrollment rate of 22 departments increased,and the enrollment rate of 8 departments increased significantly.Conclusion The establishment of DRG intelligent management system and multi-department cooperation are conducive to improving the quality of medical insurance settlement data and helping the hospital's lean management.