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随着我国社会医疗保障体系的不断发展和完善,我市新型农村合作医疗保险制度、公费疗制度与医保并轨,医院医保工作也从最初的面向参保人员的政策咨询、解释、宣传及解决参保人员与医院之间的纠纷、办理相关医保手续。进一步发展到对患者医疗费用的监测与审核。该文通过对日常医保审核工作中常见问提的分析、提出相应的防范措施、最大限度地减少医保拒付问题的发生。
With the continuous development and improvement of social medical security system in our country, the city’s new rural cooperative medical insurance system, public health care system and health insurance merger, the hospital health insurance work also from the initial policy for the insured personnel to consult, explain, publicize and solve the problem Insurance personnel and the dispute between the hospital, for the relevant medical insurance procedures. Further development and monitoring of patient medical costs and audit. Through analyzing the frequently asked questions in daily medical insurance audit, this paper puts forward corresponding preventive measures to minimize the occurrence of medical insurance protest.