1. Medical security work report
In the city of medical security department of the correct guidance and help, in the district party committee, the district government attaches great importance to and strong support, in order to serve the majority of insured patients for the purpose of the hospital, the hospital all staff unity and cooperation *** with the same efforts, so that our hospital's medical insurance work health The hospital's health insurance work healthy and smooth operation.
First, strengthen the medical insurance policy publicity
In order to create a good atmosphere for the whole society to pay attention to the medical insurance and participate in the medical insurance, we make full use of the "May Day" eve of the labor security policy publicity day, October's labor security publicity week, take to the streets, walk into the community, into the enterprises and institutions, into the school, to take the consultation, leaflets, banners, etc. Consultation, leaflets, slogans and other forms of health insurance, the object of participation, payment methods, medical treatment, difficult groups to participate in the preferential policies, etc. vigorously publicized.
Second, change the style of work, establish the concept of service
The purpose of medical insurance work is to serve the majority of insured patients, for the majority of the insured service should not become an empty slogan, in the specific work of the need for a professional, dedication, integrity, efficiency, and willingness to serve the insured patients of the medical staff team, so according to the requirements of the municipal health insurance, the whole hospital Comrades actively participate in each city health insurance training and learning, through learning, combined with the actual work of medical insurance, in the ideological concepts, work style, work methods, and strive to achieve three changes, set up three concepts, that is, to change the concept of thought, set up the concept of the big picture, the general public, the overall situation, and keep pace with the times. The purpose of medical insurance work is to effectively enable the majority of insured patients to have timely treatment, the medical costs incurred in accordance with the policy provisions of timely reimbursement, through the hard work of the medical staff, so that the majority of insured persons are satisfied; change the work style, set up the concept of service. The purpose of medical insurance work is: to serve the majority of insured patients, therefore, we serve the insured patients as the center, how to provide quality service for insured patients throughout the work, the work adhere to the principle of fairness, justice and openness, objectivity and impartiality, patience and meticulousness, and often work overtime is a very common thing, and sometimes work overtime to work to the late night two, three o'clock; change the working method, set up the concept of responsibility. Responsibility concept, health insurance reform is a brand new work, no successful experience can be directly borrowed, and is directly related to the majority of insured patients' personal interests, therefore, we carefully study the policy theory at the same time, to the cause of the responsible spirit of the insured, in the spirit of both the rescue of the sick and the insured patients of the interests of the principle of studying business knowledge in order to be able to master the work of health insurance policy, improve the level of business. The company's business is to improve the quality of its services.
Third, improve the system, strengthen the management, and constantly improve the level of medical insurance management
Our hospital medical insurance work is still in the preparatory stage, the hospital leadership attaches great importance to this, and actively coordinate with the telecommunications company to open the network to the higher authorities to fight for the establishment of the network system funds to ensure that the medical insurance related equipment as soon as possible to prepare complete. At the same time, the hospital to improve the system, strengthen the management, optimize service efforts:
First, the charges, fees, drug prices announced to the public, accept the group from the supervision;
The second is to improve the system, from the admission registration, hospitalization, hospitalization, compensation and other aspects of the medical work, standardize the behavior of health insurance services, the implementation of strict accountability system;
The second is to improve the system, from the admission registration, hospitalization, compensation for various medical work, standardize the behavior of health insurance services, strict implementation of the system;
Third, the hospital continued to carry out "three excellent and one satisfied" (that is, beautiful environment, quality service, excellent order, so that the people are satisfied) activities;
Fourth, the strengthening of the medical insurance service consciousness, change the working style of medical staff, and effectively improve the management of medical insurance work.
Fourth, strengthen the learning, focusing on the connotation of the construction
In order to make the hospital workers have a deeper understanding of the health insurance policy and system and a comprehensive grasp of the hospital has carried out a variety of forms of learning activities:
First, held a hospital staff conference, the middle cadres meeting, etc., to explain the new health care policy, the use of meetings to deepen the understanding of the work of health care;
Second, to further improve the learning and training of medical staff, and to enhance the understanding of the work of health care. p> The second is to further improve the learning and training system, every Friday regularly organize the staff to carry out relevant theory, labor security policies and regulations and medical insurance business knowledge learning, so that the hospital staff's ideological awareness, business level and all the ability to be strengthened.
2. Medical insurance work report
In order to further improve the management of our basic medical insurance, according to the "on the Zhongmou County basic medical insurance sentinel medical institutions and sentinel retail pharmacies for 20xx annual service quality assessment notice" document spirit, the leadership of the hospital to attach importance to the establishment of the health center The basic medical insurance self-examination work leading group, actively carry out the basic medical insurance self-examination work, is summarized as follows:
First, the basic medical insurance management system is becoming more and more perfect.
I set up by the director in charge of the hospital as the leader of the basic medical insurance management work leadership group, clear members of the division of responsibilities, the center site designated full-time health insurance monitors, timely detection of a variety of health insurance violations, strict control of social security departments to develop a variety of health insurance assessment indicators, the development of a three Guanmiao Township Center Health Center, the basic interim measures for the management of health insurance, standardize the basic health insurance of the management, implement the reward and punishment system, and the basic health insurance management, the basic health insurance management. Management work, the implementation of the reward and punishment system, medical insurance work and medical staff medical ethics and medical style annual assessment and performance pay link.
Second, to strengthen the basic medical insurance related policy learning, publicity.
Regularly strengthen the medical staff to the basic medical insurance related policy learning, so that they can skillfully to the patient positive publicity of the basic medical insurance policies and regulations, can skillfully implement the basic medical insurance regulations; in the outpatient hall set up the medical insurance policy bulletin board, in the place of more patients placed in the medical insurance publicity pamphlets, so that the patient timely understanding of the basic medical insurance policy regulations.
Third, the strict implementation of the basic medical insurance designated medical institutions medical service agreement.
The hospital strictly enforces the contents of the medical service agreement of the designated medical institution for basic medical insurance, hangs the plaque of "designated medical institution for basic medical insurance" at the main entrance of the hospital in accordance with the regulations, sets up the flow chart of medical insurance in the outpatient hall, which is convenient for the insured people to consult the clinic, and sets up the charges for the basic medical items and the drugs in the outpatient hall. Price bulletin boards are set up in outpatient halls for basic medical item charges and drugs; medical charges are clearly marked; clinical medical personnel check the identity of the insured according to the regulations to prevent fraudulent insurance; computerized charging system and outpatient medical insurance leading query system for medical insurance management and medical charging are being built intensively at all central sites to realize computerization and networking; medical personnel are strictly required to use medicines reasonably and are forbidden to prescribe medicines for other people. "; in accordance with the provisions of the implementation of the standards of entry and exit hospitals and transfer, referral standards.
Fourth, improve the complaint monitoring mechanism.
The establishment of a complaint monitoring mechanism, the establishment of a basic medical insurance complaints mailbox, timely processing of all types of complaints of basic medical insurance, the violation of basic medical insurance of all types of violations of the seriousness of the implementation of reward and punishment measures.
V. Problems.
1, part of the medical staff of the outpatient medical insurance policy is not thorough enough to understand, the future will be targeted to strengthen the individual medical staff to learn the policy of medical insurance.
2, some clinicians issued outpatient medical insurance prescription is not standardized, mainly omitted to fill in the prescription of basic items and the existence of modified prescription habits, the future will strengthen the management of medical insurance prescription.
Sixth, on the work of health insurance recommendations.
It is recommended that the health insurance reimbursement program is simpler and more convenient.
3. Medical insurance work report
20xx year I hospital staff closely around the hospital purpose, unity, *** with efforts to continuously improve the level of medical care, optimize the medical environment, improve the attitude of the service, the hospital's social and economic benefits steadily increased, the work of all achievements. Under the leadership of the leading group of medical insurance work, in the health insurance staff at all levels and the active support and cooperation of all medical staff, our hospital's medical insurance work carried out smoothly, over the past year, *** receiving medical insurance patients outpatient xx times; hospitalization xx times. The hospital's medical staff enthusiastically received patients with medical insurance, with excellent medical skills, quality service, reasonable fees to win the recognition and praise of patients. Throughout the year, the hospital did not occur due to "medical insurance" a case of dispute, did not receive a complaint, no medical errors and accidents, by the patients consistent high praise.
First, the strict implementation of management regulations, and actively accept social supervision:
According to the adjustment of the health insurance policy, this year, our hospital to further improve and revise the health insurance management system to adapt to the new policy. At the same time, in order to minimize errors in the work, the medical insurance section together with the accounting section, financial section, quality control section, medical section of the medical insurance information to implement the "five halls of review", *** with the verification of reporting materials, the formation of the verification and inspection notification, so that the medical staff dynamic grasp of the relevant situation, and timely rectification, in order to ensure the quality of medical insurance work. Under the leadership of the medical insurance leading group and the medical insurance section, all the medical and nursing staff comply with the rules and regulations, standardize the operation, strictly implement the medical insurance management regulations, no violation of illegal operation. Prescriptions and medical records are written in a true, accurate, timely and complete manner, insisting on reasonable treatment, reasonable examination, reasonable medication and treatment of diseases; when using or administering medicines and treatment items outside the directory, the staff can fulfill the obligation to inform the patients and their family members of their consent and sign an informed consent form to be filed with the medical records; there is no indiscriminate billing and escalation of charges; there is no decomposition of the number of services and decomposition of the phenomenon of charging; they are able to strictly control the criteria for admission and discharge to make the rate of compliance with the diagnosis of discharge and admission reach the level of 1.5 percent. The diagnosis compliance rate of discharge and admission reaches more than 98%, and there is no hospitalization with hanging beds, no unreasonable shortening or prolonging of hospital bed days, no hospitalization with hanging beds, no hospitalization with impersonation and other phenomena occurring. Standardize out-of-town referral procedures, timely referrals for patients who meet the conditions for referrals and transfers for referrals and transfers, this year, 5 out-of-town medical treatment, out-of-town referral rate, the cost of medicines, out-of-catalog out-of-pocket expenses for medicines are controlled in the scope of the policy.
In order to better accept the supervision of the community, the hospital in the outpatient and inpatient clinics set up a "complaint box", published a report phone, and timely collection of patients' comments and suggestions, and constantly improve the management of our medical insurance.
Second, strengthen the policies and regulations to learn, do a good job of health insurance knowledge propaganda:
In order to allow medical staff to familiarize themselves with and understand the policies and regulations of health insurance, in order to provide more comprehensive service to the insured patients, the hospital took advantage of the time to convene a general meeting of all employees and the morning meeting, and many times to carry out the knowledge of health insurance learning, and to convey the new health insurance policies and regulations in a timely manner. On October 8, the medical insurance department organized a medical insurance policy training for all the hospital staff, so that all the medical staff can understand the policy and be familiar with it to better serve the insured patients. In order to improve the service consciousness of medical staff, the hospital also organized a number of knowledge tests on medical insurance policy and standardized service, prescription management and application of antimicrobial drugs, and the test scores were up to standard. At the same time, the hospital timely update health insurance knowledge bulletin board content, for employees and patients to publicize the process of medical treatment and the main examination, treatment, drug charges, etc., to facilitate the patient's access to medical care; medical insurance insurance management personnel often visit the ward to answer questions from patients, so that the majority of insured patients have a fuller understanding of the health insurance, in the clinic have a clearer direction.
Third, to strengthen the health insurance designated publicity efforts to expand the hospital's influence in the insured population:
In order to allow the majority of insured people to understand the hospital for the health insurance designated service units, recognize the hospital technology, talent, service, price and other advantages of medical treatment, so that insured patients with eye diseases to enjoy a more professional medical care, the hospital to take advantage of the physical examination, meetings, clinics, etc., the issuance of popular science promotional materials, to expand the hospital's external communication and collaboration and influence. Expanding the hospital's external communication and collaboration and influence to improve the hospital's acceptance rate in the medical insurance participants, in order to allow more participants to accept our professional, efficient, high-quality ophthalmology specialty services.
Over the past year, under the correct leadership of the Municipal Bureau of Labor and Social Security and the Municipal Bureau of Medical Insurance, and with the efforts of the entire hospital staff, through the implementation of the activities mentioned above, the hospital's medical insurance work has made certain achievements, and the influence of the society has gradually risen, with more and more patients coming to the hospital for treatment, which has been recognized by the management department of the medical insurance. However, the management of health insurance is a difficult, detailed work requirements, strong policy work, in the achievement at the same time, some of the work is still to be further improved.
The plan is to carry out the work of health insurance from the following aspects:
First, to strengthen the contact with the Bureau of Health Insurance, the strict implementation of various medical policies and regulations, in accordance with the "designated medical institutions service agreement" operation, to strengthen the medical staff health insurance policies and regulations of the study and training and examination, and timely notification of the new medical insurance policy, improve service quality, improve access to health care services, and improve the quality of health care services, and to improve the health care services. The company is also working to improve the quality of its services, improve the environment and service attitude, and actively cooperate with the Bureau of Medical Insurance in its work.
Second, to further enrich and improve the hospital health insurance management system and work responsibilities, according to the needs and the new regulations of health insurance, the establishment of health insurance bulletin boards, so that insured persons can keep abreast of the new information on health insurance.
Third, standardize the operation of the operating procedures, according to the clinical needs of the appropriate supplement to some commonly used drugs or testing equipment, as far as possible to meet the needs of patients.
Fourth, increase publicity to further expand the hospital's external influence, and strive to sign a service agreement with the counties (cities) Health Insurance Bureau, the use of hospital personnel, services, prices, technical advantages for more insured persons to provide specialized ophthalmology medical services, and in accordance with the relevant provisions of the internal organization of the quality of service inspection on a regular basis, and found that the problem, to carry out timely and effective rectification.
Fifth, the call for all employees to pay attention to the work of health insurance, actively support the work of health insurance, and strive to create health insurance "A" level designated medical institutions.
4. Medical insurance work report
20xx in our hospital leadership attaches great importance to, in accordance with the work plan arranged by the Bureau of Medical Insurance, follow the "grasp the spirit, understand the policy, vigorously publicize, and steadily promote the implementation of the" general idea. Ideas, seriously carry out all the work, after the hospital's medical staff *** with the efforts of the hospital's medical insurance work has achieved certain results, now will be the hospital's medical insurance section work is summarized as follows:
First, the leadership attaches importance to the propaganda efforts
In order to standardize the behavior of diagnosis and treatment, to control the irrational increase in medical costs, low prices, quality services, to ensure the healthy and sustainable development of health care management, my hospital The leadership team attaches great importance to unify thinking, clear objectives, and strengthened organizational leadership. Established by the business dean specifically grasp the medical insurance work leading group. The clinical departments accordingly set up to the section chief as the leader, the head nurse for the deputy leader of the working group, to be responsible for the overall management of the work of the medical insurance, focusing on the specific implementation of the medical insurance system and the implementation of the system of rewards and penalties.
In order to make the majority of cadres and workers have a deeper understanding of the new health insurance policy and system and a comprehensive grasp, we have carried out a wide range of publicity, education and learning activities:
Firstly, the entire hospital staff conference, middle-level cadres meeting, explaining the new health care policy, the use of meetings to deepen the understanding of the work of the health insurance.
The second is to organize health insurance knowledge training courses, blackboard newspaper, distribution of publicity materials, and other forms of enhancement of the staff on the daily work of the health insurance operation capacity.
Third, to strengthen the hospital's information management, through the medical insurance software management, can be more standardized, more convenient. Greatly reduce the occurrence of errors. Fourth, through the TV album to publicize the health insurance policy, so that the majority of health insurance personnel, urban residents, students and other friends really understand the benefits of insurance, understand the mode of operation of the hospital, and actively participate in the health insurance activities.
Second, the measures are effective, strict rules and regulations
In order to make the health insurance patients "clear, clear consumption", our hospital:
First, in the hospital outside the publication of the health insurance clinic flow charts, the hospitalization of patients with health insurance instructions, so that the insured patients at a glance. And in the hall arranged full-time guide, responsible for the relevant patients to provide health insurance policy advice.
Second, the configuration of the computer touch screen, electronic display, the charges, fees, drug prices announced to the public, accept the group from the supervision.
Third, the full implementation of inpatient costs "one-day list system", and require patients or patients' families to sign the list, and the implementation of health insurance accounts open public system, consciously accept supervision. So that hospitalized patients to consume clearly. In the leadership to hospital inspection, was fully affirmed.
Fourth, in order to further strengthen the responsibility to standardize the behavior of medical services, from the admission registration, hospitalization, discharge compensation for the three links to regulate the behavior of health insurance services, the strict implementation of accountability, and strictly deal with the responsible person.
Fifth, the hospital staff to carry out services, brush card system, with civilized manners, quality service, excellent technology by the patient praise.
In order to grasp the work of health insurance, the hospital combined with the actual work:
First, the hospital has developed the management rules and regulations of health insurance services, there are regular evaluation of health insurance services (service attitude, quality of medical care, cost control, etc.) work plan, and regular evaluation, the development of improvement measures.
The second is to strengthen the ward management, frequent ward visits, bedside policy propaganda, seek the views of patients, solve problems in a timely manner, check the phenomenon of hanging beds, check the phenomenon of impersonation, check the phenomenon of inpatient hospitalization with or without two certificates and a card, for patients who do not meet the requirements of hospitalization, the medical insurance section will not be approved. Strengthen the department charges and medical staff of the diagnosis and treatment behavior supervision and management, supervision and inspection, timely and serious treatment, and be informed and exposure.
Third, improve the service attitude, improve the quality of care
The new health insurance system to the development of our hospital has brought unprecedented opportunities and challenges, because of the work of the health insurance has a correct understanding of the hospital cadres and staff are actively engaged in this work, hard work, each in his own way, each responsible for.
I regularly down to the wards to participate in the morning meeting, timely communication of the new policy and feedback on the quality of medical care found in the audit process of the Bureau of Medical Insurance. By paying close attention to medical quality management, standardized operation, purified medical unreasonable charges, improve the management of medical staff, medical insurance awareness, improve the quality of medical care for the insured to provide a good medical environment.
In the process of handling employee health insurance procedures, my window staff actively publicize to every insured employee / resident, explaining the relevant provisions of health insurance, relevant policies, various subsidies, seriously answer all kinds of questions, tirelessly explain the policy, and dedicated to provide services. We endeavor to ensure that no insured patient or family member leaves with dissatisfaction or doubt. We always put the highest priority on "providing high quality and efficient services for insured patients". In the process of medical insurance operation, the majority of insured and enrolled patients are most concerned about the compensation of medical expenses. In line with the "convenient, efficient, clean, standardized" service purpose, the staff of my section strict control, friendly operation, the implementation of one-stop service, on-the-spot delivery of medical assistance costs, greatly improving the satisfaction of the insurance.
Fourth, the work of the summary
Through the staff of my section and the whole hospital related staff of the *** with efforts, serious work, sincere service to patients, the successful completion of the beginning of the year the established tasks. 20xx our hospital *** admitted to the health insurance patients 2486 times, medical costs totaled 20.66 million yuan, reimbursement of 11.6 million yuan, out-of-pocket expenses of 590,000 yuan, 10,000 yuan or more 5 times, outpatient hospitals and hospitals, and the hospitals and the hospitals and the hospitals and the hospitals and the hospitals and the hospitals and the hospitals. yuan more than five times, outpatient chronic disease 126 people, amounting to 78,000 yuan, greatly reducing the burden of the masses to see a doctor.
Our hospital health insurance work in the process of carrying out the health insurance bureau leadership and staff of the strong support coupled with the correct leadership of the hospital leadership, the hospital's medical staff vigorously cooperate to make the work of the health insurance can be carried out smoothly. In the future work, the need to strictly policy off, starting from the details, seriously sum up the experience, and constantly improve the system, and seriously deal with the internal operation mechanism and the relationship between external window service, standardize the business process, simplify the procedures, and strive to do more and better for the health care personnel services, and strive to our hospital's health care work to a new height, for the county health care work to contribute to the smooth development of the work. In 20xx year's work, although we have made some achievements but there are still some shortcomings, but we are convinced that in the new year, under the strong support of the Bureau of Health Insurance, the leadership of the correct leadership of the hospital, we will certainly be the health insurance this work is completed more outstanding, the benefit of the county's health insurance personnel.
5. Medical insurance work report
My main responsibility in the hospital is the work of the medical insurance, and now there has been a year of time, time is very short, there is no achievement can be told, the work of my year to report to you.
1, since January 1, 20xx our hospital outpatient transactions 1272, 51 hospitalizations, 49 settlements, 2 in the hospital, hospitalized patients involved in Daxing, Dongcheng, Xuanwu, Chaoyang, Chongwen five districts and counties, is now smooth settlement of 46: the cost of 721,477.37 yuan; unsettled 3: the cost of 24271.34 yuan. There is no refusal to pay in the settled costs, and the outpatient hospitalization data uploaded by health insurance patients is accurate, with no garbage data feedback.
2, from January to carry out the work so far in the hospital health insurance system is running normally, in April due to the system causes health insurance machine can not work properly, timely contact with the first letter of the company and the system to repair, meticulous search for the cause of the problem, timely installation of antivirus software. In the year of xx, the hospital's medical insurance machine has been updated and installed 13 times in time, and every time we can do the latest update, the hospital's medical insurance system will be upgraded at the first time in time. During the May hospital his system transformation, do a good job of health insurance outpatient hospitalization interface to successfully complete the health insurance patients directly his entry and then imported into the work of the health insurance computer.
3, do a good job with the health insurance center of the upload and download work, for the work of the problem can be resolved in a timely manner. xx year to participate in the urban and rural health insurance center organized by the meeting of the training six times in September 23rd of the implementation of the card training to retrieve the card reader two, SIM card machine three, health insurance card trial card, the implementation of the card will be in the beginning of next year to start in the suburban counties.
xx year to meet the district social security center inspection twice, xx September 14, the district social security center Yan director of a three-member team of our hospital's medical insurance work from the quality of medical records, prices, fee management, medical insurance system used in several aspects of the supervision and inspection, affirmed the hospital's work at the same time pointed out the shortcomings in the work. After the inspection, according to the problems raised by the supervisory team to seriously rectify, and will rectify the report to the district health insurance center. xx October 15, the district social security center of the hospital's health insurance situation for the inspection of the hospital to the staff to participate in the social insurance made a high evaluation.
4, medical insurance work is a complicated work, from the drug catalog to the diagnosis and treatment catalog, and then to the service facilities catalog, each of which requires careful examination, thanks to the help of all colleagues, it is your assistance to make the work of the medical insurance work smoothly, xx year of the hospital staff from the policy provisions of the medical insurance, the hospital can be admitted to the patient, the reimbursement requirements of the medical insurance, medical insurance, such as the attention to several aspects of training knowledge of the medical insurance. The company's website has been updated with the latest information on the company's website, including its website and its website.