1 basic status quo of hospital bills
In recent years, with the continuous development of the national health sector, the hospital's economic scale is getting bigger and bigger, more and more charging outlets within the hospital, bills sent and received frequently, the use of a particularly large number of management difficulties have also increased. At present, there are two main types of fee bills used in hospitals, namely, special bills and uniform bills. Among them, special bills mainly include outpatient fee bills (manual, mechanism), outpatient registration receipts, hospitalization fee bills (manual, mechanism), hospitalization advance payment receipts, etc., are administrative fee bills, the amount collected must be paid in full to the financial account, not to be diverted without authorization. Uniform bills are mainly for the local Finance Bureau unified use of administrative institutions current receipts. These bills are an important tool to realize the income of the hospital, but also an important part of the safe management of funds. In recent years, some hospitals have neglected the management of bills, one-sidedly think that the blank bills are just a few pieces of paper, negligent control, resulting in individual fee earners have a crooked mind, use the loopholes in management, from which the misappropriation, borrowing, embezzlement of funds, to the hospitals to bring about unnecessary economic losses and adverse effects [2]. Therefore, effectively strengthen the hospital bill management, can protect the safety of hospital funds, strengthen the financial internal control system, to ensure that the hospital safe, stable and sustainable development.
2 main problems of hospital bill management
2.1 leadership attention is not enough, the staff awareness is weak hospital charges generally only involves the Finance Department, and the Finance Department is relatively independent department, and most of the dean or financial division dean is a medical expert origin, less knowledge of financial knowledge, it is inevitable that the use of bills, custody of the work of negligence;; the vast majority of hospitals have implemented micro-computerized charges, and the financial system, and the hospital has been the most effective way to ensure the safety of hospital funds, strengthen the financial internal control system, to ensure the safe, stable and sustainable development of hospitals. The vast majority of hospitals have implemented micro-computerized management of fees, but for various reasons, the cultural level of fee-charging staff, business level and other uneven, but also did not go through professional training, can only be mechanically charged; management system is not in place, the arbitrary replacement of bill management personnel, resulting in unclear bill management responsibilities, management disconnect, not only increases the management of the Department of management in the management of bills, audit, write-offs and other aspects of the difficulty, but also very easy to Formation of management loopholes.
2.2 The current management mechanism is not adapted to the new situation with the reform of the medical system continues to advance, large hospitals will continue to strengthen the scientific research, teaching, training and other social functions, hospital revenue channels will gradually increase, multi-channel inflow of funds to lead to the type of hospital financial charges have become more complex, the original bill management methods will not be able to adapt to the needs of the rapid development of hospital business at this stage. In accordance with the principle of voluntary reimbursable use of temporary charges, such as parking fees and equipment, facilities and premises rent, many of the charges are not the object of administrative units, the use of administrative charges and administrative units of current receipts is certainly not appropriate.
2.3 The use of fee bills is not standardized mainly in the current settlement bills and fee bills use scope is not clear, the invoicing staff of the main body of the bill is inaccurate understanding of the feeling into the main criteria for the issuance of the bill. The use of bills does not conform to the provisions of the local financial sector, such as the amount received do not know what kind of bills to open, fill in the content is incomplete, the handwriting is blurred and unclear, randomly altered, inconsistent with the upper and lower coupons. In addition, there are loopholes in the management of the receipt, recovery and cancellation of bills, and many bills are not canceled in time after the expiration date.
2.4 management means backward, difficult to query the bills many hospitals in the accounts, budget management has reached the level of computerized, but most of the hospital's fee bills are still using the traditional manual record mode of management, i.e., the bills of the collar, the pin, the summary of the information are manually filled out by the bill administrator. General "ledger" management can only be used on the bills of the unit's receipt, return, balance of a general impression, it is difficult to correct the improper use of bills in a timely manner in the process of fee charging, not to mention the query of bills, in the management of bills in a passive position.
3 improve the management of hospital bills countermeasures
3.1 leadership attention, strengthen the publicity and learning hospitals to strengthen financial management, standardize the charging behavior, and put an end to arbitrary fees, it is necessary to pay attention to the management of bills. Finance Department can strengthen the system and policy publicity through the management manual, website, expert lectures and other ways to publicize more about the national financial laws and regulations relating to the management of fees and bills and the importance of bill management, so that the use of bills to make the leadership of the unit and individuals fully aware of the understanding of the use of bills and management work. Hospital leaders should urge the establishment of the unit of the fee bill purchasing, use, storage, acceptance, write-off system discipline, for the fee bill management system, standardization and make positive efforts.
3.2 The competent authorities should adapt to the new situation bill authorities should give full consideration to the specific business of the current hospital to issue various types of bills. At present, certain scientific research and service activities involved in hospitals are already in line with the scope of issuance of VAT invoices, then the tax authorities should approve the use of VAT invoices in hospitals. The receipts for administrative and institutional transactions have already brought great inconvenience to the normal activities of hospitals, then the competent departments should take into account the development of hospitals' business and design new charging invoices to meet the needs of hospitals' business development. In addition, for the current charging situation, there is an urgent need to reduce the types of bills and reduce the difficulty of using them. This not only facilitates the supervision of the management department, but also facilitates the internal management of the using department.
3.3 standardize the daily management of bills standardize the management of bills first of all to improve the bill receiving and selling registration system; second, the hospital should be clear management responsibility, the chief of the financial department should be the first person responsible for and set up a full-time bill management positions, responsible for the daily management of the hospital's fee bills; again, set up the bill management account, to ensure that the bill management work of standardization and standardization. Among them, the daily management of bills mainly from the following links to start:
3.3.1 bill acquisition hospitals use all the fee bills must have a financial department bill administrator with the price department's fee license, to the financial sector to apply for the "bill quasi-purchase certificate". According to the types approved in the "Invoice Quasi-purchase Certificate" and the hospital's daily use of invoices, the Controller will purchase invoices from the Municipal Finance Bureau's Invoice Management Center, and will not allow other departments and other personnel to purchase financial fee invoices.
3.3.2 Bill collection and use of chargeable bills should pay attention to the following: First, after the hospital purchases bills, they should be accepted by the Finance Department and registered by the bill administrator as the date of purchase, name, starting and ending numbers, specifications and quantities of the chargeable bills, and the channel of purchase should be indicated. Secondly, according to the workload of outpatient and inpatient collectors, the bill administrator shall give quantitative collection of fee bills, which shall be controlled in principle in the amount of one week's use, and shall set up sub-accounts according to the collectors. Third, for administrative transactions bills can only be used by the cashier of the Finance Section.
3.3.3 Write-off bills write-off management is a rather trivial, quite important work, which should pay attention to two points: First, the fee can not stay in the hands of the fee payer for too long, to return to the time limit to prevent the loss of the bills or fee payers do not hand over the receipts; second, the bill administrator should be based on the receipts of the receipts returned to the receipt of receipt stubs in a timely manner to handle the registration of write-offs of the bills. Write-offs to the stub copy (or accounting link) and the daily statement as the basis for careful checking: outpatient receipts to the bill collector checkout in the receipt interval number and the daily statement as the basis; hospitalization receipts to the bill collector in the daily statement of the receipt interval number and the daily statement as the basis for the receipts; administrative and business transactions receipts to the recipient to the stub copy of the return of the receipt as the basis for the amount of the account with the link to check each one to take a sheet by sheet Write-offs are made on a sheet-by-sheet basis. In addition, in order to strengthen the management of blank bills, the receipt of bills not written off in a timely manner, in principle, shall not be allowed to receive new bills; at the same time, the bill administrator should promptly identify the reasons for the failure to write off the bills.
3.3.4 bill refund, void bill refund, void link management is particularly important, first of all, should develop a strong operation of the fee bill refund, void management regulations, including hospital fee bill refund, void operation process, approval authority, refund basis, etc., in order to ensure that the hospital's revenues are fully accounted for; secondly, should be strictly audit pass, refund, void fee bill is Secondly, the audit should be strict, refund, cancel the bills are all in, whether in accordance with the provisions of the refund, void, such as lack of drugs in the pharmacy, the patient does not want to accept the examination and treatment after payment of the bill for refund and other reasons and void, must be the pharmacy operator, the treatment of the doctor's signature to confirm before reporting to the audit staff to cancel, in order to prevent the charges and the payment of the person to collude (after the receipt of the payment of the person does not need to reimbursement of the charges to be voided or refunded to embezzlement of public funds). The financial section of the bill administrator in accordance with the provisions of the daily review of all refunds and voided bills, item by item, check, and regularly analyze the reasons for refunds, voided. In addition, the hospital audit section should also be used to carry out regular checks and audits of the bills, at the same time, the unit's fee bill management as an important part of a variety of economic and financial inspections, in the inspection process, the early detection of problems and solve the problem, in order to ensure that the hospital's economic interests are not lost.
3.4 The introduction of computer management with the gradual improvement of the hospital HIS system, can be ticket requisition, ticket receipt, ticket write-off, etc. through the hospital HIS system to complete the realization of the fee bills of the computerized, intelligent management mode, the situation of each bill is stored in the database to facilitate the automatic query of the computer of the bill stubs, to improve the efficiency of the management of the hospital's charging bills. In addition, the management system of the financial and tax bill management department can also be networked with the bill management system of the hospital to realize the resource ****sharing and facilitate the financial and tax bill management department to monitor the bills of the university instantly. Bills management as an important part of charge management, but also an important task of hospital financial management, the level of its management directly affects the efficiency of hospital financial management. With the increasing expansion of hospital business, bill management work will also be increasingly aggravated and complicated, only in the management process of continuous learning and thinking, in-depth analysis and research of new issues that arise, in order to continue to promote the smooth management of hospital charges bills to ensure the healthy and coordinated development of medical care.