The difference between the medical insurance settlement list and the first page of the patient's case

The State Medical Insurance Bureau launched the development of 15 business coding standards for medical insurance information in August 2018, in accordance with the overall requirements of "unified planning, unified classification, unified coding, unified release, unified management." In June 2019, the database and dynamic maintenance platform of coding standards for disease diagnosis and surgical operations, medical service items, drugs and medical supplies were the first to go online. On September 26th, 11 medical insurance information business coding rules and methods were announced, including medical insurance fund settlement list, designated medical institutions, medical insurance physicians, medical insurance nurses, designated retail pharmacies, medical insurance pharmacists, medical insurance system units, medical insurance system staff, medical insurance outpatient chronic and special diseases, medical insurance settlement by disease, medical insurance day surgery, etc. At the same time, 11 medical insurance information business coding rules and methods were announced in the State Medical Insurance Administration (SMEA). At the same time, a window for "dynamic maintenance of the database of medical insurance information business coding standards" has been opened on the website of the State Medical Insurance Bureau. Among them, "medical insurance fund settlement list" is the first list, hereinafter referred to as "medical insurance list", for the implementation of the DRG is of great significance.

The medical insurance list includes basic information, outpatient chronic disease treatment information, hospitalization treatment information, medical fee information in several categories. Its main function is to meet the medical insurance audit and settlement, disease group management, big data analysis needs. The list is universally applicable and can be used in various types of medical institutions, various types of medical treatment, and various types of existing payment methods, which provides a basic guarantee for the unification of national settlement data standards and big data analysis. The design concept is mainly taken from the first page of the case, the bill and other settlement vouchers; the data taken from the first page of the case is consistent with the first page, the data taken from the bill is consistent with the classification items on the medical fee bill, and the data is unique and uniform normative. In addition, the list of medical insurance data collected directly from the hospital system, without having to fill in manually.

A list of styles:

1, the basic information in the designated medical institutions, newborns admitted to the hospital information.

Age less than one year old, fill in the method with the original there are some differences, the original: 15/30, now fill in the 15,

Newborn admission type: normal, preterm, disease and other indicators for DRG grouping.

2, hospitalization information: admission, diagnosis, surgical operations, nursing, discharge information; which ventilator time, intensive care unit for the DRG payment of important information.

3, medical charging information: *** 91 data items, 14 categories of charges can cover all cost categories in medical charges, all mandatory items; after the standardization of the standard, to solve the problem of the major categories of charges in various regions are messy and the standard is not the same; charging information and the Ministry of Finance in August 2019 issued the latest version (medical fee bill 2019 version) to maintain consistency, the application for settlement of information: you can cover a variety of payment methods such as by project, single disease, disease score, DRG, by bed day, by headcount, and so on.

Second, the list of medical insurance VS the case home

1, the purpose of different

List: the list of data submitted when applying for the settlement of costs, an important tool to carry out big data analysis.

Home: to improve the scientific, standardized, refined, information management level of medical institutions, strengthen medical management and control, improve case management, and provide a technical basis for payment reform.

2, the list contains the type of admission of newborns, treatment categories, diagnostic code counts, health insurance payment methods.

3, the list contains detailed information on the fund payment.

4, the list does not have anesthesia classification, surgical level, incision information, death autopsy, drug allergies and other information not related to the payment relationship.

5, the list of ICD using the medical insurance version of the code, the home page is usually used in a variety of versions of the clinical version, such as the State Pro, the national standard, Beijing, Shanghai and other versions, the later will be unified into the State Pro 2.0 version.

The list is not the first page, the list originates from the first page, the list is different from the first page.