Practice and Effect of Reconstructing Medical Insurance Settlement List Management Process Based on HIS System
Objective To solve the problem that the information of diagnosis and operation on the first page of inpatient medical record is transferred to the medical insurance settlement list,which leads to the abnormal results of Diagnosis Related Group.Methods To adjust the work flow of medical record coder,"medical insurance settlement diagnosis"and"medical settlement operation"were added to the hospital information system,and the whole process plan of linkage and information sharing with medical insurance fund settlement list uploading business was designed based on the hospital information system transformation.Results The first page of inpatient medical records and the medical insurance settlement list could be accurately and completely reported according to the filling specification.The quality of the medical insurance settlement list was significantly improved,the success rate of uploading was increased from 60%to 98%,and the uploading time was shortened from the original average 10 days to 5 days,the Group of ambiguities(QY group)decreased from about 20%to 5%.Conclusion Based on the personalized process transformation of hospital information system,the management mode of the whole process of the medical insurance settlement list is established,the management level of the hospital is improved,and the quality of the first page of the inpatient medical record and the quality of the medical insurance settlement list is guaranteed.
diagnosis related groupmedical insurance settlement listfirst page of inpatient medical records
NETL
NSTL
万方数据
