Current location - Trademark Inquiry Complete Network - Tian Tian Fund - The difference between medical insurance settlement list and medical record home page
The difference between medical insurance settlement list and medical record home page

in August, 218, according to the general requirements of "unified planning, unified classification, unified coding, unified release and unified management", the National Medical Insurance Bureau initiated the formulation of 15 medical insurance information business coding standards. In June 219, four coding standard databases and dynamic maintenance platforms, including disease diagnosis and surgical operation, medical service items, medicines and medical consumables, were first launched. On September 26th, 11 medical insurance information business coding rules and methods were published, including medical insurance fund settlement list, designated medical institutions, medical insurance doctors, medical insurance nurses, designated retail pharmacies, medical insurance pharmacists, medical insurance system units, medical insurance system staff, chronic and special diseases in medical insurance clinics, medical insurance settlement diseases by diseases, and medical insurance daytime surgery diseases. At the same time, the window of "Dynamic Maintenance of Medical Insurance Information Business Coding Standard Database" was opened on the website of National Medical Insurance Bureau. Among them, "medical insurance fund settlement list" ranks first, hereinafter referred to as "medical insurance list", which is of great significance to the implementation of DRG. The medical insurance list includes basic information, outpatient chronic disease diagnosis and treatment information, inpatient diagnosis and treatment information, and medical charge information. Its main function is to meet the needs of medical insurance audit and settlement, disease group management and big data analysis. The list has universal applicability, and can be used in various types of medical institutions, various types of medical treatment, and various existing payment methods, which provides a basic guarantee for unifying the national settlement data standards and big data analysis. Its design ideas are mainly taken from the first page of medical records, bills and other settlement vouchers; The data taken from the first page of medical record is consistent with the first page, and the data taken from the bill is consistent with the classification items on the medical charge bill, and the data has unique and unified standardization. In addition, the medical insurance list data is collected directly from the hospital system without manual filling. 1. List style: 1. Designated medical institutions and newborn admission information in basic information. For those under one year old, the filling method is different from the original one. The original one is 15/3, and now it is 15. The type of newborn admission: normal, premature delivery, disease and other indicators used for DRG grouping. 2. Hospitalization information: information on admission, diagnosis, operation, nursing and discharge; Among them, the use time of ventilator and the important information of payment for DRG in intensive care unit. 3. Information on medical charges: ***91 data items, and 14 categories of charges can cover all categories of charges in medical charges, all of which are required; After unifying the standards, it solved the problems of miscellaneous charges and different standards in various regions; The charging information is consistent with the latest version (219 version of medical charging bill) issued by the Ministry of Finance in August 219. The application settlement information can cover various payment methods such as by project, single disease, disease score, DRG, bed day and per head. Second, the medical insurance list VS the medical record home page 1. List of different purposes: the data list submitted when applying for fee settlement is an important tool for big data analysis. Home: Improve the scientific, standardized, refined and information management level of medical institutions, strengthen medical management and control, improve medical record management, and provide technical basis for the reform of payment methods. 2. The list includes the type of newborn admission, treatment category, diagnostic code count and medical insurance payment method. 3. The list contains detailed information on fund payment. 4. There is no information unrelated to the payment relationship such as anesthesia grade, operation level, incision information, death autopsy, drug allergy, etc. in the list. 5. ICD in the list uses the code of medical insurance version, and clinical versions of various versions are usually used in the home page, such as the national standard, national standard, Beijing, Shanghai and other versions, which will be unified into the national standard version 2. later. The list is not the home page, the list comes from the home page, and the list is different from the home page.