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.
关键词
医保结算清单/诊断组/自动排序/预先审核
Key words
medical insurance settlement list/diagnosis group/automatic sorting/pre-approval review
维普
万方数据