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定点医疗机构是医疗保险服务的载体,脱离了医疗服务,医疗保险将无从谈起。特别是在患者被动医疗消费的情况下,定点医疗机构如何按“规则”推销医疗服务,已成为医保政策顺利实施的关键。山东省烟台市面对花样繁多的医保骗保行为,加大了稽查力度,先后三次对市区所有定点医院执行医疗服务协议的情况进行夜间稽查。在稽查过程中,凡是参加医保的住院病号,逐一核实身份,做到六查:一查病情诊断;二查大夫医嘱;三查门诊病历;
Fixed-point medical institutions are the carriers of medical insurance services, out of medical services, medical insurance will be impossible. Especially in the case of patients’ passive medical spending, how the designated medical institutions to promote medical services according to “rules ” has become the key to the smooth implementation of the medical insurance policy. Yantai City, Shandong Province in the face of a large variety of health insurance fraud, to increase the audit efforts, has three times in all urban hospitals designated hospitals to implement the medical service agreement for night inspection. In the audit process, all participating in medical insurance inpatient disease, one by one to verify the identity, so six check: a check the disease diagnosis; two check the doctor’s order; three check the medical records;