摘要
目的: 保证医疗机构上传的医保结算清单质量,提高CHS-DRG分组方案的信度和效度。方法: 医疗机构通过解读医保结算清单信息采集标准,建立相关的管理组织架构及岗位职责,形成基于医保结算清单的采集管理流程。结果: 规范的信息采集标准、健全的管理组织架构及岗位职责是完成医保结算清单信息采集管理流程的重要保障。结论: 规范的信息采集标准是保证医保结算清单质量的前提,健全的管理组织架构是基础,明确的岗位职责是核心环节,完善的信息化建设是助力。
Abstract
Objective: The paper attempts to ensure the quality of medical insurance settlement list, improve the reliability and validity of the China Healthcare Security Diagnosis Related Groups (CHS-DRG) grouping scheme. Methods: By interpreting the information collection standard of medical insurance settlement list, medical institutions establish the relevant management and organization structure as well as job responsibilities, and form the collection and management process based on the medical insurance settlement list. Results: The standardized information collection standards, sound management and organization structure as well as job responsibilities are important guarantees for the completion of the information collection and management process of medical insurance settlement list. Conclusion: Standardized information collection standards are the premise of quality assurance, sound management and organization structure is the basis, clear job responsibilities are the core link, and excellent informatization construction is the assistance.
关键词
医保结算清单 /
采集标准 /
组织构架 /
岗位职责
Key words
medical insurance settlement list /
collection standards /
organization structure /
job responsibilities
石艺, 胡牧, 顾馨苡, 栾丽华.
基于医保结算清单的医院信息采集管理流程[J]. 中国医疗保险. 2024, 0(10): 96-101 https://doi.org/10.19546/j.issn.1674-3830.2024.10.014
Hospital Information Collection and Management Process Based on Medical Insurance Settlement List[J]. China Health Insurance. 2024, 0(10): 96-101 https://doi.org/10.19546/j.issn.1674-3830.2024.10.014
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基金
国家医疗保障局医疗保障事业管理中心自行采购项目“DRG典型试点城市案例研究”（JHWT20220901）
