病案质量对医保大额医疗费用赔付的影响

社会医疗保险的支付方式中，年度超过10万元以上的大额医疗费用的理赔由大额保险办公室通过审核病案、核对清单进行实际支付，病案已成为大额医保理赔的重要依据，但实际工作中常因书写不规范、管理不严谨等问题导致医院医疗费用被拒付。本文旨在分析病案的书写、管理质量对大额医疗费用理赔产生的影响，并提出提高病案书写质量及加强病案管理的相应措施，以保证在病案书写、整理、装订、质控、归档等各个环节的有效管理，减少医保大额医疗费用拒付的产生。

The Impact of Medical Records Quality on Claims of Significant Amounts Medical Expenses of Medical Insurance

In the ways of payment of the social medical insurance, claims of large medical expenses over 100,000 for the year are actually paid by large-value insurance offices after they audit medical records and check the lists. Medical records have been important bases for claims of significant amounts of medical insurance, but in practical work, medical expenses of hospitals are often refused to pay because of non-standard writing, non-strict management and so on. This article aims to analyze the impact of writing and management quality of medical records on the generation of large-value claims and proposes corresponding measures to improve writing quality and enhance management of medical records to ensure effective management in all links among writing, finishing, binding, quality control and archiving of medical records and reduce generation of significant amounts of non-pay- ment of medical insurance.