病案质量与医保拒付问题的分析及对策

病案是医疗保险机构支付医疗费用的重要依据,针对医保拒付的病历进行分析,发现存在着病历首页、入院记录、诊断证明书缺乏真实性;病程记录、手术麻醉记录单、医嘱单、自费协议记录不准确;检验单、辅助检查报告单及大型耗材条形码缺乏,未及时归档的问题。需要我们提高对病案重要性的认识,提高病案质量,加强病案的真实性、完整性及准确性;加强医务人员的岗前培训及继续教育;规范三级医师查房制度;建立系统的奖惩制度;提高病案质量及医保管理内涵;加强信息化依托;从而有效地减少医保拒付。

The Analysis and Relevant Countermeasures of Medical Records Quality and Medical Insurance Dishonor

Medical records are important basis of the medical expenses afforded by the health insurance institutions.Through analyzing of the medical insurance dishonor medical records,we found lots of problems,such as the home pages,hospital records and certificate of diagnosis were lack of authenticity,the register of progress notes,anesthesia records,doctor’s advice and the self-supporting agreements were inaccurate,the absence of inspection sheets,auxiliary examination reports and the bar code of large supplies,as well as failed to timely filed.So we should improve our awareness of the importance of medical records, promote the quality of medical records,strengthen the authenticity,integrity and veracity.Enhance Pre-service training and continuing learning of medical personnel,specify the three levels of physician rounds regime,establish systematic reward and punishment system,improve the quality of medical records and the connotation of medical records management and strengthen the support of informatization,thus decrease the medical insurance dishonor effectively.