According to the conditions of qualified departments in the hospital, formulate the charge control standards of each department, sign the charge control responsibility letter with the department, and strictly follow the principle of "three reasonableness". If it is really necessary to continue treatment, and the cost exceeds the examination and approval of the medical department, the treatment can be continued only after passing the examination and approval. If the expenses are not approved, they will be deducted from the performance appraisal of the department.

XXX hospital medical insurance work assessment related responsibility book

Party a: XXX hospital

Party B: _ _ _ _ _ _ _

In order to further improve the medical insurance management system and medical expense control system, the principles of reasonable inspection, reasonable treatment and rational drug use are strictly followed, medical services are standardized, and the basic medical needs of the insured people are effectively guaranteed. According to the designated medical service agreement of social medical insurance (work-related injury and maternity) in XX city, the Interim Measures for the Settlement of Social Medical Insurance Expenses in XX city (No.XXXXXXXX) and the Notice on Adjusting the Control Index of Hospitalization Expenses of Basic Medical Insurance and the Standard of Medical Expenses Quota of Credit Insurance in XX year (No.XXXXXXXXX) were formulated, and the relevant assessment responsibility book for medical insurance work in our hospital was formulated in combination with the actual situation of our hospital. The specific assessment rules are as follows:

1, be familiar with the policies related to medical insurance, and consciously fulfill the service agreements and regulations of designated medical institutions. Seriously publicize and explain the medical insurance policy to the insured.

2, clinicians should implement the responsibility system for the first diagnosis, strictly grasp the hospitalization standards, do not prevaricate, refuse to participate in the insurance, do not induce the insured patients to be hospitalized, and do not ask the insured to leave the hospital in advance or delay the discharge under various excuses. When accepting the insured, carefully check the medical insurance certificate and put an end to fake outpatient service. For the insured in hospital, the system of on-site visits shall be strictly implemented to prevent false hospitalization, empty bed hospitalization and hanging bed hospitalization, and the calendar of medical insurance for the insured shall be kept centrally, and the ID card of the insured shall be copied and pasted in the medical record for future reference. If the insured fails to draw a card for emergency admission in time, remind him to draw a card for hospitalization within 24 hours.

3, clinicians should adhere to the principle of "treatment due to illness", strictly implement the drug list, diagnosis and treatment items and medical service facilities and payment standards. Reasonable inspection, reasonable treatment and rational drug use, strict implementation of prescription management measures, no large prescriptions, no excessive inspection, no abuse or over-range use of antibacterial drugs, and no over-range prescription (acute disease for 3-5 days, chronic disease for 7- 10 days; Chronic diseases and special diseases that need long-term medication can be extended to 30 days, while the maximum dosage of Chinese medicine decoction is no more than 15, and the reasons must be indicated).

4. For the insured persons admitted with clear or suspected crimes, fights, alcoholism, drug abuse, illegal abortion, food poisoning, collective food poisoning, work-related injuries, traffic accidents, etc., we should seriously ask about the medical history, make a detailed and truthful medical record, and form a medical record, and shall not tamper with, destroy or transfer the medical record.

5. Standardize the writing of special medical records for medical insurance, and ensure that medical records, prescriptions, doctor's orders, medicines, medical services, prices, charges, lists and bills are consistent.

6. When using drugs, special medical materials and medical services that need to be borne by the individual in whole or in part for the insured, the patient or his family members shall be informed in writing and signed.

7, strictly implement the "XXXXXX hospital annual medical insurance control standard" per capita hospitalization expenses not more than _ _ _ _ _ _ _, really need to continue treatment, the implementation of the examination and approval system, must be reported to the medical department, after examination and approval, can continue treatment, if not approved, will be handled in accordance with the relevant provisions. Medical insurance expenses exceeding the standard shall be handled in accordance with the provisions of Item 9, Paragraph 6, Article 8 of the comprehensive target assessment scheme of XXX Hospital.

8, in violation of the relevant policies of medical insurance, will be implemented according to the relevant documents; In violation of the provisions of the investigation, the expenses incurred shall be implemented in accordance with the relevant provisions of the Measures for the Treatment of Medical Accidents.

Hospital President (signature) Department Director (signature):

XXXXXx year x month XXXx year x month