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一个市县新农合管理办公室,每月要审核处理上百万条报销数据;每个新农合管理人员,平均要管理近4万名参合人员,是全国平均水平的2倍,新农合凭人力监管异常数据难度极大,导致骗保、欺诈事件频发。在此背景下,海南省自主开发新农合智能审核系统,并在日前实现全省覆盖,应用于全省各级各类定点医疗机构门诊、住院报销审核工作。记者了解到,2009年~2013年间,海南省新农合参合率连续保持在95%以
A city and county NCMS office shall review and process millions of reimbursement data every month. Each new NCMS manager has to manage an average of nearly 40,000 participants, twice the national average. NRCMS With human supervision of unusual data extremely difficult, leading to fraud, fraud frequent. In this context, Hainan Province independently developed the new rural cooperative medical audit system, and recently achieved coverage in the province, applied to all levels of the province’s designated medical institutions out-patient, inpatient reimbursement audit. This reporter learned that, from 2009 to 2013, Hainan Province, the new NCMS cohesion rate remained at 95%