Exploration and Practice of Medical Insurance Settlement List Management in the Context of DIP Payment
Objective To explore methods for improving the data quality of medical insurance settlement lists and reducing payment losses caused by data quality issues. Methods Technologically,a diagnostic group entry platform,automatic synchronization and sorting functions for surgical operations,a decision support system,a verification function for the cover page of medical records,and validation functions for both central and hospital data were implemented. Managerially,a data review mechanism for the cover page of medical records and a pre-review mechanism for medical insurance settlement lists were established. Results The success rate of the first upload of medical insurance settlement lists increased by 50.17 percentage points,the defect rate of cover pages decreased by 80.44 percentage points,and the hospital's overall Case Mix Index (CMI) value increased by 0.13. Conclusion Utilizing information technology and establishing review mechanisms are important measures for improving the management level of medical insurance settlement lists.
medical insurance settlement listdiagnosis groupautomatic sortingpre-approval review
万方数据
维普
