Improve the supervision rules and regulations of hospital medical insurance fund: fully implement the "Regulations on the Supervision and Management of the Use of Medical Insurance Fund" and other laws and regulations, set up a medical insurance fund supervision and management Committee to raise awareness and strengthen organizational leadership; Regularly carry out self-examination and self-correction of hospital medical insurance fund, strengthen the long-term mechanism of medical insurance fund supervision, constantly promote fund supervision, further standardize medical service behavior, build a strong fund security defense line, and ensure the safe, efficient and rational use of medical insurance fund.
Multi-department collaborative supervision: set up a special supervision working group in conjunction with various departments, issue supervision notices, and the heads of various departments are responsible for each section. Through data screening, surprise verification and medical record review, the full coverage of supervision and inspection of clinical medical departments in the whole hospital is realized to ensure that there is no dead angle in supervision and inspection. In view of the problems of signs and tendencies, we pointed out the crux of the problem on the spot, ordered immediate rectification, made irregular return visits, strengthened the deterrent force of inspection, and strictly adhered to the "high-voltage line" of fund supervision.
Implementation of assessment and rewards and punishments: Based on the multi-dimensional indicators such as the list of violations of medical insurance funds, detailed rules for self-examination and self-correction, and the assessment of hospital comprehensive target management responsibility system, an assessment system for the use of medical insurance funds suitable for hospital development is formulated, which is assessed monthly according to the use of medical insurance funds in various departments, and rewards and punishments are reflected in the monthly hospital comprehensive target management responsibility system assessment form.
Effect of medical insurance fund supervision
1, the interests of the insured are safeguarded and the security of the medical insurance fund is guaranteed.
Through multi-department collaborative supervision, the supervision system of hospital medical insurance fund has been improved, the organization and leadership have been strengthened, the understanding has been improved, the main responsibility has been compacted, the division of responsibilities has been clarified, and the assessment and reward and punishment system has been improved. Through full coverage and high-frequency publicity, a good supervision atmosphere of medical insurance fund has been formed; Using information system, realize the whole process supervision of medical insurance fund use. Thereby effectively safeguarding the interests of the insured and effectively ensuring the safety of the medical insurance fund.
2. Improve the ability of hospital diagnosis and treatment.
By strengthening the supervision of medical insurance fund, the hospital has established a set of perfect supervision measures for medical insurance fund, so that clinical departments can carry out reasonable examination, medication and diagnosis and treatment in strict accordance with clinical diagnosis and treatment guidelines, clinical technical operation norms, industry standards and other related requirements. This can not only prevent the occurrence of insurance fraud, but also promote the departments to improve their professional ability, thus improving the comprehensive diagnosis and treatment ability of the hospital and providing better and efficient medical services for the majority of medical staff.
Reference to the above content: Baidu Encyclopedia-Regulations on the Supervision and Administration of the Use of Medical Insurance Funds