分解住院也称二次返院、二次入院,一般是指医院在住院患者尚未痊愈的前提下,为病人多次办理出院、住院手续的行为。“分解住院”现象产生的基本原因是,基本医疗保险经办机构对住院病人实行次均定额结算,对每次住院限定了医保基金的支付限额,超过该限额,医保基金将降低支付比例甚至完全拒绝支付,医院将要承担部分甚至全部医疗费用。“分解住院”是一种严重违反医疗保险规定并侵犯患者权益的行为。本审计方法重点是通过医保信息管………一、审计思路 Decomposition of hospital also known as the second return to the hospital, the second admission, generally refers to the hospital inpatients have not yet recovered under the premise of the patient discharged, hospitalization procedures. The basic reason for the “decomposed inpatient” phenomenon is that the basic medical insurance agency administers sub-fixed-rate settlements for inpatients, and limits the payment limit of the medical insurance fund for each hospital stay, and the medical insurance fund will reduce the payment proportion Even completely refused to pay, the hospital will have to bear some or all of the medical costs. “Decomposing a hospital” is a serious violation of the provisions of medical insurance and violating the rights and interests of patients. The focus of this audit is through the health insurance information management ... ... A, audit ideas