20 19 classic medical insurance self-examination report: 5 articles.

20 19 classic medical insurance self-examination report template (1)

Under the guidance of the district medical insurance center, with the support of leaders at all levels and relevant departments, and in strict accordance with the policies, regulations and requirements of the state, city and district on medical insurance for urban workers, we will conscientiously fulfill the Medical Service Agreement of designated medical institutions for basic medical insurance for urban workers in xx City. Thanks to the correct leadership of the leading group headed by the president and the joint efforts of the medical staff in our hospital, the medical insurance work in xx was generally running normally, and there were no cases such as excessive expenses, borrowing cards to see a doctor and out-of-range inspection. To a certain extent, it cooperated with the work of the district medical insurance center and maintained the safe operation of the fund. At present, our hospital has conducted a self-examination of the medical insurance work in xx years, and compared the evaluation methods.

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Carefully investigate and actively rectify, and now report the self-inspection as follows:

First, raise awareness of the importance of medical insurance.

In order to strengthen the leadership of medical insurance, our hospital set up a medical insurance work leading group composed of relevant personnel, defined the division of responsibilities to people, and ensured the implementation of medical insurance work objectives and tasks from the system. Organize all the staff to study the relevant documents carefully for many times, find out the gap, and actively rectify according to the actual work in our hospital. Focusing on the future and keeping pace with the times, * * * will discuss the next medical insurance work and create a new situation of harmonious medical insurance. Our hospital regards medical insurance as a major event in the hospital, actively cooperates with the medical insurance department to strictly control non-conforming treatment items and drugs that should not be used, and resolutely puts an end to the illegal phenomenon of defrauding medical insurance funds.

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Strengthen self-discipline management and promote our hospital to strengthen self-supervision, self-management and self-discipline. Further establish a good image of designated hospitals for medical insurance.

Two, strengthen the management of medical insurance from the system.

In order to ensure the implementation of various systems, the hospital has improved various medical insurance management systems, focusing on the medical insurance objectives and tasks arranged by superiors in combination with the actual work of our hospital. Formulated regulations and reward and punishment measures to further strengthen the management of medical insurance, and stipulated the responsibilities of personnel in various positions. The basic medical insurance system is sound, the relevant medical insurance management information is complete, and it is managed and filed according to the norms. Carefully and timely complete all kinds of documents, write medical records, nursing medical records and course records, and upload real medical insurance information to the medical insurance department in time.

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Three, from the reality to do real medical insurance management.

According to the actual work of our hospital, the hospital strictly implements the regulations on the management of basic medical insurance drugs. All drugs, diagnosis and treatment items and medical service facilities should be clearly marked and a detailed list of expenses should be provided. And repeatedly stressed to the medical staff that it is necessary to verify the identity of the medical staff and prevent the phenomenon of impersonation.

Fourth, through self-examination, it is found that although the medical insurance work in our hospital has made remarkable achievements, there is still a certain gap from the requirements of the medical insurance center, such as the basic work needs to be further consolidated. Analysis of the above shortcomings, mainly for the following reasons:

1, individual medical staff do not attach importance to medical insurance work ideologically, do not study medical insurance thoroughly in business, have insufficient understanding, and do not know what to do, what not to do and what to do.

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Do it in time.

2. In the process of seeing a doctor, there is a phenomenon that the medical insurance process is not fully mastered.

3. The writing of medical records is not timely and comprehensive.

4. Failing to accurately upload the medical insurance data such as the disease diagnosis, drugs, diagnosis and treatment items of the insured.

5. The focus of the next step.

In the future, our hospital should strictly implement the policies and regulations of medical insurance and consciously accept the supervision and guidance of the medical insurance department. In view of the above shortcomings, the next step is mainly to take measures:

1, strengthen the study of medical staff's medical insurance documents and knowledge, improve their understanding ideologically, and put an end to carelessness.

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2, the implementation of the responsibility system, clear in charge of the leadership and medical insurance management responsibilities, strengthen the inspection and education of medical personnel, establish an assessment system, so that rewards and punishments are clear.

3. In the future, we should strengthen the communication between doctors and patients, strive to build a harmonious relationship between doctors and patients, and constantly improve patient satisfaction. The basic medical needs of the insured are fully guaranteed. By improving the medical quality and service level of our hospital, the recognition and support rate of the insured and all sectors of society for medical insurance work will be enhanced.

20 19 classic medical insurance self-examination report template (2)

Human Resources and Social Security Bureau:

According to Luannan Human Resources and Social Security Bureau, our hospital

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On the spirit of forwarding documents. 20xx2 1 Notice on the Management of Two Designated Units issued by the Tang People's Social Affairs Office, through the efforts of the relevant staff of our hospital, comprehensively sorted out the insured persons who came to our hospital for treatment, and there were no cases such as excessive expenses, borrowing cards to see a doctor, out-of-range inspection, listing for hospitalization, changing medicine with medicine, replacing medicine with things, etc. To a certain extent, it has maintained the safe operation of the medical insurance fund. The self-inspection work is now reported as follows:

First, the basic management of medical insurance:

1, our hospital has set up a basic medical insurance management team composed of leaders in charge and relevant personnel, which is specifically responsible for the daily management of basic medical insurance.

2, the basic medical insurance system is perfect, the relevant medical insurance management information according to the standard management filing.

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3. The medical insurance management team regularly organizes personnel to analyze the use of various medical expenses of the insured. Find problems and solve them in time, and conduct spot checks on medical insurance management. If there are irregularities, they will be corrected immediately.

4, medical insurance management team members actively cooperate with the county social security bureau of medical service price and drug costs supervision and audit, timely provide medical files and related information for reference.

Two, medical insurance service management:

1, to provide quality services for the insured.

2, the drugs, diagnosis and treatment projects and medical service facilities charges clearly marked, and provide a detailed list of costs, and resolutely put an end to illegal activities such as medicine to supplement medicine, replacing medicine with things.

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3, verify the identity of the medical staff, and resolutely put an end to the phenomenon of impersonation and listing in hospital.

4, medical personnel requirements or must use drugs outside the directory, diagnosis and treatment projects, to obtain the consent of the insured and sign the document in advance.

5, by the drug supervision department to check no drug quality problems.

Three, medical insurance business management:

1, strictly implement the basic medical insurance drug management regulations and the medical insurance drug approval system.

2, according to the basic medical insurance directory required drug preparation rate.

3, check the outpatient prescription, discharge medical records, check the dispensing situation in accordance with the provisions.

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4, strictly implement the basic medical insurance treatment project management regulations.

5, strictly implement the basic medical insurance service facilities management regulations.

Four, medical insurance information management:

1, our hospital's information management system can meet the daily needs of medical insurance work, and it is also relatively perfect in daily system maintenance. It can report and actively eliminate the faults of medical insurance information system in time to ensure the normal operation of the system.

2, medical insurance window staff skilled operation skills, medical insurance policy learning actively.

3. The medical insurance data is safe and complete.

Five, medical insurance cost control:

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1, strictly implement medical charges and medical insurance quotas.

2. Strictly master the admission and discharge standards, and found no insured who did not meet the hospitalization conditions or deliberately delayed discharge and exceeded the inspection scope.

3. Submit the medical insurance expense report on time every month, and settle the expenses in time.

Six, medical insurance policy publicity:

1. Actively organize medical staff to study medical insurance policies regularly, and timely communicate and implement relevant medical insurance regulations.

2 to set up publicity columns, distribute publicity materials and other forms of publicity and education.

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After further self-examination and rectification of medical insurance work in our hospital, the medical insurance work in our hospital is more scientific and reasonable, the professional quality of medical insurance managers and all medical staff in our hospital has been improved, the sense of responsibility has been strengthened, and the bad loss of medical insurance funds has been prevented. With the support and guidance of the Social Security Bureau, the medical work in our hospital has been better.