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随着基本医疗保险覆盖面的不断扩大,医疗待遇逐年提高,医疗需求得到进一步释放,住院、特殊门诊量均大幅上涨,目前龙市市参保人员113万人,两定机构超过300家,而与此同时,医保经办机构却面临人员不足,业务水平参差不齐的问题,医疗监管工作难度加大。为应对日益严峻的医保监管形势,更好的体现医疗保险稽核的公平、公正,规范定点医院、医生的医疗服务行为,规范参保人员的医疗行为,提升医保经办机构的精细化管理
With the continuous expansion of the coverage of basic medical insurance, the medical treatment has been increasing year by year, the medical needs have been further released, and the numbers of inpatient and special out-patients have risen sharply. At present, the number of insured persons in Longshi City is 1.13 million, At the same time, the medical insurance agencies are faced with the problem of staff shortage and uneven business standards, and the medical supervision work is more difficult. In order to cope with the increasingly serious medical insurance supervision situation, it better reflects the fairness and fairness of medical insurance audit, standardizes the medical services of designated hospitals and doctors, standardizes the medical behaviors of insured persons and improves the delicacy management of medical insurance agencies