摘要
威海市医保部门聚焦医保基金监管领域的重点、难点、痛点、堵点,以制度建设为基础,以智能监控系统建设为主线,探索构建全链条、全方位、全要素的监管体系,将监管内容逐步延伸到涉及医保支付范围内医疗服务行为的各个环节,实现了医疗行为的事前警示、事中管控、事后审核的全过程监管,全面筑牢医保基金监管防线,确保医保基金健康运行.
Focusing on the key issues and diffi culties in the supervision of medical insurance fund,and based on system construction as well as intelligent monitoring system,the healthcare security department in Weihai explores and constructs a full-scale supervision system comprising control from the source,fi xed point access,daily audit,law enforcement,third-party evaluation,social supervision.The regulatory content has gradually extended to all aspects of medical services involving payment scope of medical insurance.The whole-process supervision of prewarning,in process control and post audit in medical treatment has been realized,which strengthens the supervision and insure the healthy operation of medical insurance fund.
作者
李辉
姜燕松
Li Hui;Jiang Haisong(Weihai Healthcare Security Bureau,Weihai,264200;Weihai Healthcare Security Service Center,Weihai,264200)
出处
《中国医疗保险》
2020年第4期66-69,共4页
China Health Insurance
关键词
医保基金
监管体系
智能监控
威海
medical insurance fund
supervision system
intelligent monitor
Weihai
作者简介
李辉,山东省威海市医疗保障局基金监督管理科科长,主要研究方向:医保基金监督管理。
