首页|基于医保结算清单的恶性肿瘤病案质量现状分析

基于医保结算清单的恶性肿瘤病案质量现状分析

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目的 通过提高病案质量、质控能力、规范医保结算清单的填写,保障医院经济效益.方法 重新对既往恶性肿瘤病案进行质控,借助智能医保病案协作系统,对比修订错误后的病案入组情况和标杆费用的变化,分析不同错误导致的结果,并总结正确经验.结果 错误的疾病诊断,会在医保结算时导致亏损或涉嫌欺诈,影响医疗机构经济运营.结论 医保结算清单质量的提升不仅要提升病案书写质量、编码水平,还需要通过广泛学习去读懂政策内涵.
The Malignancy Medical Record Quality Analysis by Medical Insurance Settlement List
Objective To protect the economic benefits of the hospital by improving the medical record quality,quality control ability,and standardising the filling of the medical insurance settlement list.Methods Re-quality control of previous malignant tumour cases,with the help of the intelligent health insurance case collaboration system,compare the changes in case entry and benchmark costs after the revision of errors,analyse the results caused by different errors,and summarise the correct experience.Results Erroneous disease diagnoses can lead to losses or suspected fraud in health insurance billing,affecting the economic operation of healthcare organisations.Conclusion The improvement of the quality of the medical insurance settlement list not only needs to improve the quality of case writing,coding level,but also needs to read the connotation of the policy through extensive study.

settlement listmedical record qualityeconomic operations

孙慧子、刘宇、魏爽

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齐齐哈尔医学院 黑龙江齐齐哈尔 161006

齐齐哈尔医学院附属第二医院 黑龙江齐齐哈尔 161006

结算清单 病案质量 经济运营

齐齐哈尔医学院社会科学基金项目

QYSKL2023-22YB

2024

中国医院管理
中国医院管理杂志社

中国医院管理

CSTPCD北大核心
影响因子:2.15
ISSN:1001-5329
年,卷(期):2024.44(2)
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