从财务视角探讨公立医院医保报销的风险及防范措施

Discuss the risk and preventive measures of medical insurance reimbursement in public hospitals from the financial perspective

从财务视角入手探讨公立医院医保报销的风险及防范问题对提升公立医院医保报销工作开展质量、降低客流程推进风险具有重要的意义。通过文章分析可知,公立医院医保报销环节中,比较典型的风险主要有医保报销政策解读学习风险、信息不对称风险、成本预算与核算体系完善性风险、医保费用审核环节风险。需要公立医院集中组织医保报销政策方案学习,加强业务部门与财务部门沟通力度,构建完善的成本预算与核算工作体系,提升医保费用审核工作严谨性,为从根本上规避财务部门参与公立医院医保报销工作的风险,提升风险防范成效提供支持。

It is of great significance to discuss the risks and prevention of medical insurance reimbursement in public hospitals from the perspective of finance for improving the quality of medical insurance reimbursement in public hospitals and reducing the risks of customer process.Through the analysis of this paper,it can be seen that among the typical risks of medical insurance reimbursement in public hospitals,they mainly include the risk of medical insurance reimbursement policy interpretation and learning,the risk of information asymmetry,the risk of cost budget and accounting system perfection,and the risk of medical insurance cost audit.Need public hospital centralized organization reimbursement policy learning,strengthen the business department and financial department communication,build perfect the cost of the budget and accounting system,improve health care cost audit work rigor,to fundamentally avoid the financial department to participate in public hospital health reimbursement risk,improve risk prevention results.