Objective: The paper attempts to clarify the application range of the scoring rules for healthcare security payment eligibility and establish a scientific responsibility recognition system. Methods: Based on the principle of proportionality and the perspective of coordinating institutional goals, the paper demonstrates the scoring range and proposes a scoring trigger threshold, meanwhile, it constructs a four-element attribution system from the dimensions of subjective fault, causative potency, etc. Results: The main challenges are the generalization of scoring scope and unclear identification of responsibilities. Threshold setting can prevent the generalization of responsibilities, and the four-element system can distinguish between primary, important, and general responsibilities. Conclusion: Precise accountability can help improve the efficiency and institutional credibility of medical insurance fund supervision.