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目的降低医保剔除费用,减少对医院的经济损失。方法:对医保剔除经费的原因进行分析,并针对原因实施对策。结果通过加强与医保管理部门沟通、利用电脑软件辅助监管、完善临床路径、加强医护人员培训和医院内部加强自查自纠来规范诊疗行为,降低医保剔除经费。结论通过规范诊疗行为,降低剔除经费,使病人、医保监管部门及医院三者共赢。
Purpose To reduce the cost of medical insurance and to reduce the economic loss to the hospital. Methods: To analyze the reasons for excluding medical expenses, and to implement countermeasures for the reasons. Results By strengthening communication with medical insurance management department, using computer software to assist supervision, improving clinical pathway, strengthening training of medical personnel and strengthening self-examination and self-correction within the hospital to standardize the diagnosis and treatment behavior and reduce the medical insurance deduction funds. Conclusions By standardizing the practice of treatment and reducing curtailment funds, the patients, the health care supervising department and the hospitals all win the win.