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随着我国医保制度全覆盖,定点医院医保收入大幅提升,医保业务风险成为医院财务管理的重要组成部分;建立完善的医保财务风险的控制系统,提升医院整体管理水平,确保医院遵循“鼓励节约、减少浪费、保障基本医疗”的财务管理原则,按照“因病施治、合理检查、合理用药、合理收费”等要求开展医疗活动,合理保证单位经济活动合法合规、资产安全、财务信息真实完整,防范舞弊和预防腐败、提高公共服务的效率和效果,促进医保医疗卫生事业可持续发展。本文结合内部控制五目标就定点医院医保财务风险及其控制措施提出思考和建议。
With the full coverage of the medical insurance system in our country, the medical insurance revenue in designated hospitals has risen substantially, and the risk of medical insurance business has become an important part of hospital financial management. The establishment of a sound medical insurance control system for financial risks has led to the improvement of overall hospital management and to the hospital’s compliance with “ , Reduce waste and ensure basic medical treatment ”, carry out medical activities in accordance with the requirements of“ rule of disease treatment, reasonable inspection, rational use of medicines and reasonable charges ”to reasonably ensure that units’ economic activities are lawful and compliant, assets are safe, Real and complete financial information, prevent fraud and prevent corruption, improve the efficiency and effectiveness of public services, and promote the sustainable development of medical and health care. In this paper, five goals of internal control in fixed-point hospital medical insurance financial risk and its control measures are put forward and suggestions.