医院医保费用门诊拒付问题探讨

目的探讨医院医保费用门诊拒付情况,为有效降低医保拒付提供解决方法。方法分析我院近期13个月医保费用门诊拒付情况。结果我院13个月医保门诊拒付金额110 176.31元,拒付3 072例,其中97.53%是临床医生违反医保、医政、药监规定造成,加强监管后拒付金额及人次明显下降。结论医保拒付的原因是多方面的,医保管理部门需要应用现代化信息加强与临床医生、参保人员的联系,更好发挥监管、服务作用。

Exploration of outpatient non-payment problems of hospital medical insurance costs

Objective To investigate the outpatient non-payment situation of hospital medical insurance costs in order to provide solutions to effectively reduce medical insurance non-payment.Methods The outpatient non-payment situation of medical insurance costs in the recent 13 months in our hospital had been analyzed.Results The amount of outpatient nonpayment of medical insurance in the 13 months was 110 176.31 yuan for 3 072 cases,of which 97.53% were caused by clinicians’ violation of medical insurance,medical affairs and drug administration regulations.The amount and person-time of non-payment obviously reduced after strengthening regulations.Conclusion There are various causes of non-payment of medical insurance and therefore medical insurance management department needs to apply modern information to strengthen the links with clinicians and the insured in order to play a better role in regulation and services.