Zhangjiagang City,Jiangsu Province began to carry out DRG pilot work in October 2022.In order to ensure the security of medical insurance funds,Zhangjiagang healthcare security departments explored a new model of fund supervision under DRG,established and improved the Medical Insurance Smart Eye intelligent monitoring and supervision platform,and dug into the application value of medical record data in monitoring violations of medical institutions.This paper analyzes the manifestations and causes of major violations when county medical institutions provide inpatient services under DRG payment,expounds how the Medical Insurance Smart Eye intelligent monitoring and supervision platform realizes the construction of supervision model,operation process and effect evaluation,summarizes the shortcomings of current intelligent supervision and puts forward suggestions for improvement,providing a replicable experience for other regions to promote the intelligent supervision of health insurance funds under DRG payment.
关键词
DRG支付/医保智能监管/医疗违规行为
Key words
DRG payment/intelligent supervision of medical insurance/medical violations
万方数据