目的: 提升医保结算清单质量,夯实DIP付费基础。方法: 从完整性、规范性和合理性三个维度分析样本地区医保结算清单质量现状,探索构建闭环质控管理模式,并从干预前后对比分析该模式的实施效果。结果: 2023年质控未通过的清单数8.75万份（占比8.12%）,其中完整性、规范性、合理性问题分别占3.51%、11.18%、8.85%。从质控规则库建立、前置质控数据校验、问题实时反馈、医疗机构及时修订等板块探索构建医保结算清单闭环质控管理模式;该模式实施后,2024年1-6月质控未通过清单数占比降至2.67%。结论与建议：当下医保结算清单质量有待提高,规范性和合理性问题较为突出。可通过构建闭环质控管理模式,多部门合作提高医保结算清单的内涵质量,加强信息系统建设,不断优化质控规则,提升数据治理能力,赋能医保基金高效运行。

Objective: The paper attempts to improve the quality of the medical insurance settlement list and consolidate the DIP payment foundation. Methods: The paper analyzes the current status of the medical insurance settlement list quality in the sample areas from the three dimensions of completeness, standardization and rationality, explores the construction of a closed-loop quality control management model, and compares and analyzes the implementation effect of the model before and after the intervention. Results: In 2023, there were 87500 lists (accounting for 8.12%) that failed the quality control, of which completeness, standardization, and rationality issues accounted for 3.51%, 11.18%, and 8.85%, respectively. A closed-loop quality control management model for medical insurance settlement lists was built from the establishment of quality control rule database, pre-quality control data verification, real-time feedback of problems, and timely revision of medical institutions. After the implementation of this model, the proportion of the number of unqualified lists from January to June 2024 dropped to 2.67%. Conclusionsand Suggestions: At present, the quality of the medical insurance settlement list needs to be improved, and the problems of standardization and rationality are more prominent. Through the construction of a closed-loop quality control management model and multi-department cooperation, the connotation and quality of the medical insurance settlement list can be improved. Also, we should strengthen the construction of information systems, continuously optimize quality control rules, improve data governance capabilities, and empower the efficient operation of medical insurance funds.