What does the medical insurance bureau usually check during the inspection?

1, whether the hospitalization standard is reduced; Whether there are patients who can be treated in the outpatient department of the hospital.

2. Whether the charge, examination, medication and treatment are reasonable, that is, "four reasonableness", and whether the doctor's advice, checklist, expense list (prescription) and course record are consistent with the network system, that is, "five consistency".

3. Whether the application of antibacterial drugs is carried out in accordance with the classification management system of antibacterial drugs, and whether there is overdose, multiple combination and super-course medication.

4, whether the medical record is true, whether there is a copy of the medical record, inspection report, patient representative signature, and so on and so forth.

5. Whether the admission and discharge instructions comply with relevant specifications.

6, whether to check the valid documents of hospitalized patients in accordance with the provisions? Is there an impostor or hanging up the bed?

7. Are there any drugs that expand or falsify the condition and change the diagnosis and treatment items? Whether there are false diagnosis and treatment items or extend the diagnosis and treatment time.

8. Whether the unpaid medical items, medicines and consumables are flexibly recorded in the scope of payment behavior.

9. Whether to have an examination has nothing to do with the disease.

10. Is there any behavior that violates the medical service and price policy, raises the charging standard without authorization, and breaks down the charging items and charging items without permission?