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.
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, advocate quality service and facilitate the insured to seek medical treatment.
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.
3, verify the identity of the medical staff, and resolutely put an end to the phenomenon of an impostor in hospital.
4. The off-list drugs and diagnosis and treatment items that medical personnel require or must use shall be agreed and signed by the insured 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.
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:
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.
Rectification measures:
1, according to the degree of responsibility, double the punishment for the personnel of relevant departments.
2. Update procedures in time and strengthen training.
3, standardize the check system, for all drugs under the doctor's advice that day, all relevant departments must do all the treatment processes, and check the rationality according to the actual situation and condition.
4. Strengthen the cultivation of the sense of responsibility of staff in inpatient department, nurse station and pharmacy.