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中文摘要: 目的:通过对医保关于药品扣款明细进行分析,根据扣款原因,积极探讨解决方法,减少医保扣款。方法:通过医保系统,调取本院2019年2月到5月的扣款明细,对扣款原因进行分析。结果:大部分扣款原因是因为处方药品数量超过医保系统规定的最大剂量,造成医保扣款。另有少部分扣款是医保审核系统审核错误造成。结论:通过药师积极参与医保药品扣款研讨,利用信息化软件,加强对医生的宣传培训,医院落实绩效考核,可减少医保扣款。
Abstract:Objective:By analyzing the details of medical insurance deductions for drugs,according to the reasons for the deductions,actively explore solutions to reduce medical insurance deductions. Methods:Through the medical insurance system,retrieve the deduction details from February to May 2019,and analyze the reasons for the deduction. Results:Most of the deductions are due to the amount of prescription drugs exceeding the maximum dose prescribed by the medical insurance system,which causes medical insurance deductions. There are also a small number of deductions due to errors in the medical insurance audit system. Conclusion:Pharmacists actively participate in the discussion of medical insurance deductions for drugs,use information-based software,and at the same time strengthen publicity and training for doctors.The hospital implements performance evaluation to achieve the purpose of reducing medical insurance deductions.
keywords: Pharmacist Medical Insurance Deductions Audit
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章壮军.医院药品医保扣款因素分析[J].江苏卫生事业管理,2021,32(10):1328-1330.
ZHANG ZhuangJun.Analysis on Deduction of Drugs and Medical Insurance in Our Hospital[J].Jiangsu Health System Management,2021,32(10):1328-1330.
章壮军.医院药品医保扣款因素分析[J].江苏卫生事业管理,2021,32(10):1328-1330.
ZHANG ZhuangJun.Analysis on Deduction of Drugs and Medical Insurance in Our Hospital[J].Jiangsu Health System Management,2021,32(10):1328-1330.