This year's medical insurance work in the county social security bureau (medical insurance management center) under the supervision and guidance of the leadership of the hospital leadership team's concern and support, through the hospital medical insurance management team members and the whole hospital staff *** with the efforts of all the medical insurance work and a variety of medical insurance rules and regulations are becoming increasingly sophisticated and mature, and has been comprehensively stepped into the formalized, systematic management track, according to the "basic medical examination methods for urban workers in Anji County" provisions and unremitting efforts over the year, the hospital organized medical insurance management team for the 2007 basic hospital management work a comprehensive self-examination of existing problems According to the "Anji County urban workers' basic medical insurance designated institutions medical assessment methods" and the provisions of the year's unremitting efforts, the hospital organization health insurance management team of the 2007 annual basic hospital management work carried out a comprehensive self-examination of the problems one by one analysis and report the following: First, the basic management of medical insurance: 1, the hospital has a division of leadership and relevant personnel composed of the basic medical insurance management organization, and there is a specific person is responsible for the basic 2, the basic medical insurance system is sound, the relevant medical insurance management information is complete, and in accordance with the norms of management archives. 3, the medical insurance management team regularly organizes personnel to analyze the use of medical insurance to enjoy a variety of medical expenses, such as the discovery of problems in a timely manner to give a solution to the irregularities in the occasional random checks of the management of the medical insurance and corrected in a timely manner and immediately rectify the situation. 4, the medical insurance management team Personnel actively cooperate with the county health insurance center on medical service prices and drug costs of supervision, audit, timely provision of medical files and related information that need to be accessed. Medical insurance business management: 1. Strictly implement the basic medical insurance drug management regulations, and strictly implement the medical insurance drug approval system. 2. Basically achieve the drug preparation rate required by the basic medical insurance catalog. 3. Randomly check outpatient prescriptions, discharge medical records, and inspection and dispensing of medication in accordance with the regulations. 4. Strictly implement the regulations on the management of the basic medical insurance diagnosis and treatment program. 5. Strictly implement the regulations on the management of basic medical insurance service facilities. 6. Service facilities management regulations. Medical insurance cost control: 1. Strictly implement the medical fee standards and medical insurance limit regulations. 2. The per capita cost of outpatient clinic in this year is slightly higher than the scope of the control of the proportion of medicines for the patients with medical insurance. 3. The proportion of individual out-of-pocket expenses of the insured persons to the total medical expenses is controlled within 20%. 4. Monthly statements of the medical insurance expenses are sent for review on time and the expenses are settled in time. 5. Medical insurance service management: 1. The hospital has a flow chart of medical treatment and complete facilities, which is convenient for the insured to seek medical treatment. 2. The charges for drugs, diagnostic and therapeutic items and medical service facilities are marked clearly, and an itemized list of the charges is provided. 3. Identity verification is carried out for the patients, so as to eliminate the phenomenon of impersonation of the patient and impersonation of hospitalization, etc. 4. The request for the use of out-of-diagnosis drugs and diagnostic and therapeutic items by the patient is approved by the patient beforehand. 5. For those who request for out-of-prescription medicines, the doctor writes out the prescription and stamps it with the seal of out-of-prescription, and then the patient chooses to buy the medicines on his/her own. 6. Strictly controlling the criteria for the admission and discharge of patients with medical insurance, the Office of the Medical Insurance Office randomly examined 10 cases of outpatient consultation, and all 10 cases met the requirements of filling out the records of outpatient consultation. 7. No problem of the quality of medicines after the examination by the drug supervisory department. 8. V. Health insurance information management: 1, the hospital information management system to meet the needs of health insurance work, this year, the hospital in the human, financial and material aspects of the hospital to give a greater investment. 2, the daily maintenance of the system is better, the introduction of new policies or adjustments to the policy in a timely manner to modify the policy, can be reported in a timely manner and actively exclude the failure of the health insurance information system, to ensure that the system operates normally. 3, to the window of the medical window staff to strengthen the learning of health insurance policy and strengthen the operational skills. 4, the medical window staff to strengthen the health insurance policy, and strengthen the operational skills. 4, the hospital information system health insurance data security and integrity. 5, and the health insurance center network of the front machine regularly implement anti-virus anti-virus. Publicity of medical insurance policies: The hospital regularly and actively organizes medical staff to study medical insurance policies, conveys and implements relevant medical insurance regulations in a timely manner, and randomly checks the mastery and comprehension of medical staff on various policies of medical insurance management at any time. 2. Adopting various forms of publicity and education, such as setting up publicity columns, responsible doctors going to the villages to publicize, issuing medical handbooks and publicity materials. 3. As the medical insurance management is a difficult, detailed work requirements, strong policy work, which requires us to medical insurance management personnel and all medical staff in improving their own business quality at the same time, to strengthen the sense of responsibility, and with the medical insurance center to keep in touch with the frequent communication, so that our hospital's health care work to do a better job.
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