Objective:To provide theoretical basis and practical reference for intelligent supervision of DRG payment based on big data through the introduction of Xuzhou DRG-PPS supervision mode and data analysis of intelligent supervision platform.Methods:The DRG regulatory rules triggered by six tertiary hospitals in Xuzhou City from April to December 2022 were sorted out,and the trig-ger points and connotation of the DRG regulatory rules in Xuzhou city were analyzed.Results:Through the research,it was found that the charge issue was still the focus of fund supervision,the first batch of online regulatory rules covered fewer diseases,and the cases related to malignant tumor diagnosis were the diseases triggering the most rules,and the quality of the first page of medical records needed to be further improved.Conclusion:Through the supervision of medical behavior more standardized,hospital and medical in-surance coordinated management,jointly safeguard the security of medical insurance fund.
关键词
医保基金/疾病诊断相关分组/医保监管/智能监管
Key words
Medical Insurance Fund/DRG/Medical Insurance Supervision/Intelligent Supervision
维普
万方数据