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医疗保险机构使用原始病案审核医疗保险费用是唯一的方法,所存在的弊端也逐渐暴露出来:病案使用频率高,存在诸多不安全因素;病案使用量大,归档容易出差错;患者信息容易外泄;病案使用周期长,影响临床医疗、科研和患者本人使用。建议:加强对医疗保险使用病案的管理,严格把好病案借阅关;要求临床医师规范书写病案;在实际工作中积极做好与上级医保部门的沟通协调工作,让医保管理部门了解医院;教育临床医师不做多余的检查和治疗,不开大处方,合理用药。逐渐使医疗保险机构相信医院,改为抽查审核或使用病案复印件审核医疗保险费用,还可以通过医院网络实现医疗保险费用审核或自查。
Medical insurance agencies using the original medical record review the cost of medical insurance is the only way, the disadvantages are also gradually exposed: the high frequency of use of medical records, there are many unsafe factors; the use of medical records, archiving error prone; patient information is easy to leak ; Medical records with a long life cycle, affecting clinical medical research and patients themselves. Recommendations: to strengthen the management of medical insurance use of medical records, strict screening of good medical records; require clinicians to standardize the writing of medical records; in the actual work and actively do with the superior medical insurance departments to communicate and coordinate work, so that the medical insurance management department to understand the hospital; clinical education Physicians do not do extra examination and treatment, do not open big prescription, rational drug use. Gradually, the medical insurance agencies believe that the hospital is replaced by a random inspection or a copy of the medical record to review the medical insurance expenses. The medical insurance expense audit or self-examination can also be carried out through the hospital network.