医保基金智能监管平台构建与应用

为确保医保基金合理、规范使用，以医保政策性要求为依据，利用信息化手段，构建了医保基金智能监管平台。通过构建医保审计规则库与知识库，开展医保智能审核，以事前提醒、事中监管、事后稽核方式，实现了全过程实时监管，减少了违规医疗行为发生，提高了医保基金的使用效率。完善规则库分层级管理，建立多模型融合监控体系，提高智能监管系统与临床诊疗系统的集成水平等，应是医保基金智能监管的发展方向。

Construction and Application of Intelligent Supervision Platform of Medical Insurance Fund

In order to ensure the reasonable and standardized use of medical insurance fund, based on the policy requirements of medical insurance, the intelligent supervision platform of medical insurance fund was constructed by means of information technology. Through the construction of medical insurance audit rule base and knowledge base, the intelligent audit of medical insurance was carried out, and the real-time supervision of the whole process was realized by means of pre-warning, in-process supervision and post-audit, which reduced illegal medical behaviors and improved the efficiency of the use of medical insurance fund. It is believed that the development direction of intelligent supervision of medical insurance fund will be to improve the hierarchical management of rule base, establish a multi-model fusion monitoring system, and improve the integration level of intelligent supervision system and clinical diagnosis and treatment system.