The importance of the health insurance settlement list
As DRG DIP's paid work has entered the white-hot stage, many hospitals have become "anxious" when grouping the data on the home page of medical records.
The misuse of invalid primary diagnosis codes, incorrect entry of medical service item codes, ambiguity of medical insurance payment restriction items, and inconsistencies between the main surgical selection and the main diagnosis will not affect the quality of filling in the medical insurance settlement list, and may even make the hospital face temporary losses.
A qualified medical insurance settlement list "answer sheet" can reduce the settlement cycle and improve the settlement efficiency; By standardizing the filling of data, it can also reduce the occurrence of problems such as data tampering, false settlement and duplicate settlement, and ensure the safe and effective use of medical insurance; In addition, the standardization of medical insurance settlement list data is also the "cornerstone" of hospital informatization and medical quality management.
What is the difference between the medical insurance settlement list and the first page of the medical record?
Conclusion:Hospitals need to establish an independent system for list management to standardize the completion of the list and improve the quality of the list report.
Medical Wisdom Information Medical Insurance Settlement List Management System
Based on user needs, Mr. Zhi Technology was launchedMedical Wisdom Information Medical Insurance Settlement List Management System is an intelligent software system for the quality control and management of hospital medical insurance settlement list.
Based on the requirements of relevant medical insurance policies such as medical insurance payment method reform and supervision, the system uses advanced medical information technology and data analysis technology to improve the accuracy and standardization of the hospital's medical insurance settlement list, help hospitals strengthen hospital data management under the DRG DIP payment method, give full play to the value of data, and promote the refined management and high-quality development of hospitals.
The system includes specific business functions such as settlement list generation, system preliminary review and quality control, final review, coder modification, upload, query, etc., and also provides auxiliary decision-making functions such as intelligent coding, intelligent recommendation, and intelligent review, providing full-process digital and intelligent support for medical institutions in the field of medical insurance settlement list.
Features:
01Support the whole process list management
The system includes specific business functions such as list generation, system preliminary review and quality control, review, coder modification, upload, query, etc., and supports different situations of hospitals, which can be configured to meet the actual and easy-to-operate processes of hospitals, such as for large and small hospitals, hospital coding personnel allocation, the introduction of the list of questions review mode and the full amount of audit mode.
02Built-in rich quality control rule library
The system includes the basic quality control rules stipulated by the provinces and cities (such as mandatory verification, dictionary verification, logical rationality and other verification), but also contains three kinds of quality control early warning and prompts, such as anti-set high, reverse set low, and intelligent coding, and the system combines the medical record information such as the admission and discharge records of the case, the surgical operation record, the charge details, and the doctor's order information, and carries out coding quality control according to the "Medical Security ** Settlement List Filling Specification" and the international ICD coding principles, so as to effectively intercept the mismatch of the main hand of the main patient, the missing surgery and the first sexual operation, and the complications of missing the filling, the main diagnosis selection error, the code is not specified, the anatomical part and other common problems caused by the enrollment error, to avoid the loss of medical insurance settlement caused by filling in.
03Brand-new user interaction experience
The system is designed to be user-friendly, caters to the operation Xi of hospital users, is simple to use, easy to use, and has remarkable results. The quality control interface of the list is a one-screen overview and drill-down layer by layer, which supports the retrieval of cost information, medical record information, etc., and the system clearly displays the settlement expenses in the form of an instrument progress bar, and supports early warnings and prompts for high and low multiples and other settlement methods (such as single disease and bed-day settlement). Quality control problem items can be located to the specific items of the list with one click, and the list with a serious warning level cannot be submitted, so as to avoid the occurrence of some clear problems from the root. The system supports displaying the content that is inconsistent with the homepage after modification, and gives an early warning to fill in the diagnosis and surgical codes that do not appear on the homepage.
04Comprehensive operational data analysis
Multi-angle visual data analysis, comprehensive monitoring of hospital medical insurance settlement operation indicators, support drill-down analysis from the dimensions of the whole hospital, departments, diagnosis and treatment groups, disease groups, cases and other dimensions, support horizontal and vertical comparison of departments, and help hospital discipline development and performance evaluation.