医保智能审核系统设计

目的：为规范医疗行为，控制医保费用不合理增长，提供合理医疗和优质服务，开发 HIS 与“医保智能审核平台”接口系统。方法根据医保智能审核接口规范，改造“军字一号”门诊医生工作站、住院医生工作站、住院登记、出院结算等系统流程，嵌入医保智能审核平台。结果该接口系统实现患者信息实时查询，诊疗过程及时预警，事后反馈问题减少，医保费用过快增长势头得到有效遏制。结论医保智能审核平台实现各医院间的信息共享，规范医师的诊疗行为，减少不合理收费，提高服务质量，值得推广应用。

Design of Intelligent Medical Insurance Audit System

Objective This article aims to introduce the design and application of HIS interface to “the in-telligent platform for medical insurance audit ”, in order to regulate medical treatment, control unreasonable growth rate of medical fees and provide high -quality medical service.Methods According to the intelligent interface specification of medical insurance , system processing is reconstructed by applying the intelligent platform for medi -cal insurance audit, mainly in workstations of “No.1 Military” project for outpatient doctors and in -patient doc-tors, hospital registration and hospital accounts .Results The interface system realizes patients’real -time access to their medical information and prompt warning in treatment process , which has dramatically reduced negative feedbacks and effectively curbed the over -rapid growth tendency of medical fees .Conclusion The intelligent platform for medical insurance audit helps with information sharing between hospitals , regulates doctors’diagnosis and treatment, reduces unreasonable fees and improves the quality of medical service , which is worth popularization and application.