摘要
目的运用医保前置审核,拦截住院患者医保违规用药行为,降低我院医保拒付金额。方法分析我院医保拒付条目,发现医保拒付主要原因。有针对性地从人员、信息两个角度入手,通过多部门协同构建医保前置审核中心,对住院患者医保用药行为进行有效监管。结果2020年3-12月我院医保前置审核中心通过对“重点监测名单”内药品干预,累计为我院减少159.0万元医保拒付金额。医保处方不合格率因前置审核中心干预而下降。结论住院患者医保用药前置审核干预模式可以有效降低我院医保拒付金额,值得推广应用。
Objective To prevent the medication behaviors violating the medical insurance regulations and reduce the amount of payment rejected by medical insurance,by using the prescription pre-review in hospitalized patients.Methods The main reasons of medical insurance payment rejection were identified by analyzing the items of payment rejection.Focus on two aspects of information and personnel,medical insurance pre-review center was established through a multi-sector collaboration to provide effective supervision of medical insurance medication of inpatients.Results Through supervision of key drugs with medical insurance pre-review center from March to December 2020,the amount of medical insurance payment rejection was reduced by 1.59 million yuan.The rate of unqualified medical insurance prescriptions was reduced.Conclusion Medical insurance prescription pre-review for inpatients can effectively reduce the amount of medical insurance payment rejection,and is worthy of widespread popularization.
作者
张夙
胡传文
葛琳
邵燕飞
杨秀丽
黄萍
朱立明
朱佳英
ZHANG Su;HU Chuan-wen;GE Lin;SHAO Yan-fei;YANG Xiu-li;HUANG Ping;ZHU Li-ming;ZHU Jia-ying(Zhejiang Provincial People's Hospital(People's Hospital Affiliated to Hangzhou Medical College))
出处
《医院管理论坛》
2021年第7期19-22,共4页
Hospital Management Forum
关键词
医保拒付
医保前置审核
医保处方
Medical insurance payment refusal
Medical insurance pre-review
Medical insurance prescriptions
