Analysis of Problems and Countermeasures on Grouping Feedback in DRG Point Payment
Objective:To analyze the problems and causes encountered in medical insurance case grouping feedback in a tertiary Grade-A general hospital,and to explore the measures to solve the problems.Methods:The medical insurance records and settlement lists fed back to the information system of the medical insurance department from January 1,2022 to December 31,2022 from a tertiary Grade-A general hospital were extracted to screen the cases who failed grouping feedback for analysis.Results:A total of 1 230 medical insurance records and settlement lists were fed back,among them,585 records are ineffective,with a feedback failure rate of 47.56%.There were 645 medical records with successful feedback,with a feedback success rate of 52.44%,including 125 medical records with a decrease in points after feedback,accounting for 19.38%of medical records with successful feedback,and 520 medical records with an increase in points after feedback,accounting for 80.62%of medical records with successful feedback.Conclusion:The writing quality of medical records and the correct selection of grouping are the keys to the successful grouping feedback in DRG point payment.
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