Basic Medical Insurance Audit

This article was uploaded by the paper studio: the practice and discussion of financial audit in the basic medical insurance industry. You can download the document for this article through "Download" at the bottom of this article.

Abstract: Basic medical insurance is a new field with strong policy implications and complex issues. Both financial theory and practice are constantly being summarized and innovated. After practice and discussion, the Hunan Provincial Medical Insurance Bureau emphasized the important role of hospitals in strengthening financial audits, and improved the quality of hospital financial audits by improving the financial audit process and standardizing financial audit behaviors, thereby handling the difficulties and difficulties in financial work of medical insurance. focus.

Keywords: medical insurance; financial review; practice

In the past ten years, my country’s basic medical insurance system has developed from pilot reform to full implementation. Among them, the problem of financial supervision of medical insurance is particularly prominent. In this regard, the Hunan Provincial Medical Insurance Bureau conducted in-depth research and discussion based on the development of medical insurance in Hunan

1. Practice and discussion of financial audit in the collection and payment of basic medical insurance

(1 ) The main forms and reasons for the loss of taxable funds during the collection and payment process

1. The enterprise's salary base fails to be accurately reported

The payment unit of my country's basic medical insurance premiums must truthfully report the employees of the enterprise Overview, and pay 7% of basic medical insurance premiums as required. However, many companies and units, driven by individual interests, underreport the basic salary base of their employees, and some units even conceal the salary base.

2. "Single-base" payment form

The so-called single-base payment form refers to the fact that employees in the enterprise pay for medical insurance when they join the team, and retirees and employees enjoy the same benefits. medical insurance benefits. This has led to the problem that some units may use the opportunity to participate in insurance to drive all retirees within the company to enjoy medical insurance benefits.

3. "Guarantee break period" may occur

Enterprises will have personnel changes in the process of reform and development, which may lead to the company's guarantee break period, and then funds will be lost. Attrition occurs

(2) Improve policies in the collection and payment process, strengthen financial review, and increase collection rate

1. Relevant departments strengthen basic salary review

Enterprises Medical insurance payments are mainly made in proportion to the total wages of active employees. If an enterprise or unit underreports or conceals reports, it will pay less and reduce expenditures. Therefore, strengthening the basic salary review is the primary task of medical insurance financial review, and it is also the difficulty and focus of collection work. Relevant departments can take targeted measures to address this issue. Only by strengthening the basic salary review process can we ensure the smooth progress of the follow-up work of medical insurance.

2. Strengthen publicity work

Relevant departments need to actively publicize to enterprises on the basis of understanding medical insurance and expand the scope of medical insurance collection. This will not only increase the number of medical insurance The source of insurance funds has also expanded the scope of medical insurance, allowing more people to enjoy medical insurance benefits.

3. Enterprises need to improve their medical insurance payment policies

Enterprises’ medical insurance collection staff and related financial staff must face the new changes in the current society and actively guide enterprise employees to pay insurance premiums , Increase the collection rate of medical insurance funds.

2. Practice and discussion of financial audit of basic medical insurance expenditures

(1) Strengthen the development and maintenance of computer information to ensure the quality, safety and integrity of accounting information

Since the establishment of the Hunan Provincial Medical Insurance Bureau, the accounting of medical insurance funds has been fully computerized, which not only ensures the effectiveness and accuracy of accounting work, but also ensures the quality of financial audits, ultimately improving work efficiency. First of all, the maintenance of the three catalogs in the medical insurance management system already exists in the computer network system. The fund payment ratio and self-payment ratio of medical patients are already included in the system, and the classification of diseases is also included in the system. Therefore, all basic work of medical insurance fund accounting can be completed by computers. Secondly, since our bureau implemented accounting computerization, corresponding management systems have been formulated for accounting-related software and important data, and the operating authority of different positions has been set.

(2) Strengthen financial audit during the payment process of hospitalization medical expenses, do a good job in financial settlement, and achieve the purpose of managing funds

As a qualified financial audit staff member of the labor and security department , we must act in accordance with the law and strengthen supervision and review work. You must carefully understand some legal provisions and relevant regulations and be aware of them. Relevant regulations that staff need to be proficient in include the following specifications: "Medical Service Agreement for Designated Medical Institutions", "Evaluation and Management Measures for Designated Medical Institutions", and "Interim Measures for Settlement of Medical Insurance Expenses for Urban Employees". Staff must grasp the following points during the financial review process: first, review invoices and invoices must ensure their authenticity; second, medical insurance users’ diagnosis and treatment items, medication, and self-payment ratios must refer to regulations. Settlement review to ensure accuracy; third, the logical relationship between expense declarations must be balanced; fourth, abnormal expenses must be reviewed separately to ensure their authenticity and effectiveness.

3. Give full play to the role of financial review and achieve fund management goals

With the rapid development of social economy, my country’s medical insurance reform continues to deepen, and medical insurance participants have gradually moved toward diversification. Although designated medical insurance hospitals are also increasing, many informal medical institutions still engage in insurance fraud. These unethical behaviors undermine the harmonious development of society and increase medical insurance risks. This puts forward higher requirements for the current management of my country's medical insurance funds.

First of all, relevant management departments must strengthen the medical insurance management system and strengthen every aspect of financial review so that financial supervision can play its due role. Secondly, when the existing medical insurance funds reach a balance between revenue and expenditure, the medical insurance financial review work must play a supervisory role, accurately calculate the data, and provide necessary data information for the next management decision-making.

IV. Summary

Medical insurance is related to everyone’s life and work. In addition to reporting the medical insurance status of current employees, companies must also actively participate in medical insurance for employees. Do good service. The Medical Insurance Bureau needs to properly handle medical insurance funds, strengthen the review of medical insurance funds, and comprehensively improve the efficiency of the use of medical insurance funds. Relevant departments must do a good job in the review and supervision of medical insurance funds. In addition, the Medical Insurance Bureau needs to carry out regular medical insurance publicity work to make the medical insurance work deeply rooted in the hearts of the people and achieve better development.

;