基于HIS重塑医保结算清单管理流程的实践与成效
Practice and Effect of Reconstructing Medical Insurance Settlement List Management Process Based on HIS System
徐悦 1鲁成新 1严慈敏 1李飞1
作者信息
- 1. 昆明理工大学附属安宁市第一人民医院,云南省昆明市,650300
- 折叠
摘要
目的 解决住院病案首页诊断和手术操作信息平移至医保结算清单导致医保疾病诊断相关分组(DRG)结果异常的问题.方法 调整病案编码员工作流程,在医院信息系统(HIS)中新增"结算清单诊断""结算清单手术"功能模块,打造住院病案首页及医保结算清单上传业务联动、信息共享的全流程方案.结果 住院病案首页、医保结算清单都能准确、完整地上报,医保结算清单质量提升明显,一次上传成功率由60%提升至98%,平均上传时限由原来的10天缩短至5天,歧义组(QY组)病例由原来的约20%下降至5%.结论 基于HIS的个性化流程改造,建立起医保结算清单的全流程管理模式,提升了医院管理水平,保障了住院病案首页质量及医保结算清单质量.
Abstract
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.
关键词
疾病诊断相关分组(DRG)/医保结算清单/住院病案首页Key words
diagnosis related group/medical insurance settlement list/first page of inpatient medical records引用本文复制引用
出版年
2024
NETL
NSTL
万方数据