Analysis on the Construction of Knowledge Database and Rule Database for Healthcare Fund Intelligent Auditing and Monitoring System

China Health Insurance ›› 2022, Vol. 0 ›› Issue (9) : 88-93.

China Health Insurance ›› 2022, Vol. 0 ›› Issue (9) : 88-93. DOI: 10.19546/j.issn.1674-3830.2022.9.017
Observation & Discussion

Analysis on the Construction of Knowledge Database and Rule Database for Healthcare Fund Intelligent Auditing and Monitoring System

Author information +
History +

Abstract

Construction of the knowledge databases, rule database is the fundamental to the intelligent supervision of medical insurance funds. Relying on the “two databases”, the healthcare administration can monitors the whole procedure of all parties involved. The paper illustrates the connotation, extension, function of the "two databases", introduces the typical local experience, analyzes the difficulties in data collection, standardization, integrated management, other problems at the current stage, puts forward improvement suggestions such as implementing hierarchical management mechanism, providing reference for the comprehensive establishment of intelligent monitoring system

Key words

knowledge database / rule database / intelligent monitoring / fund supervision

Cite this article

Download Citations
Analysis on the Construction of Knowledge Database and Rule Database for Healthcare Fund Intelligent Auditing and Monitoring System[J]. China Health Insurance. 2022, 0(9): 88-93 https://doi.org/10.19546/j.issn.1674-3830.2022.9.017

References

[1] 国家医疗保障局.关于印发《医疗保障基金智能审核和监控知识库、规则库管理办法(试行)》的通知:医保发〔2022〕12号.[A/OL].(2022-04-07)[2022-06-23].http://www.nhsa.gov.cn/art/2022/4/7/art_37_8067.html.
[2] 龚忆莼.规范知识库、规则库管理,推动医保基金智能监控向高层次发展.中国医疗保险[EB/OL].(2022-04-07)[2022-06-23]https://view.inews.qq.com/a/20220407A0BDWR00.
[3] 海韵. 悟透建设智慧医保的时代担当[J].中国医疗保险,2022(03):37-40.
[4] 王震.理解和推进安全医保建设[J].中国医疗保险,2022(02):5-6+9.
[5] 国家卫生健康委办公厅.关于印发有关病种临床路径(2019年版)的通知:国卫办医函〔2019〕933号[A/OL].(2020-01-02)[2022-06-23].http://www.nhc.gov.cn/yzygj/s7659/202001/b3c9e097b0c1471a969d7a63be471759.shtml.
[6] 郝春彭,谭中和.医保基金监管蓝皮书:中国医疗保障基金监督管理发展报告(2021)[R].北京:社会科学文献出版社,2021.
[7] 李天俊,滕世伟,杨华,冯海欢,孙麟.新时期优化医保智能审核系统的建议与思考[J].中国医疗保险,2022(06):70-73.
[8] 高泽勋. “大数据+医保基金监管”新模式[J].中国医疗保险,2022,(04):30-33.
[9] 李胜群,林胜双,薛辰飞,周焜.加强监管队伍建设构建监管长效机制[J].中国医疗保险,2022(06):20-25.DOI:10.19546/j.issn.1674-3830.2022.6.005.
[10] 李欣芳,屈海龙,李响,等.新时代智慧医保发展与展望[J].中国医疗保险,2022(05):60-63.

Accesses

Citation

Detail

Sections
Recommended

/