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知识库是对一个领域一项工作的规范和经验的积累,在医保监控工作中,知识库体现在监控规则和监控手段上。医保日常经办管理中积累的规范和经验,可以转化成管理知识库,提高医保监控效率,而临床规范和规则可积累成临床知识库,丰富医保监控的手段。目前,医疗保险监控处于研究和探索阶段,监控规则更多体现在对医保结算数据中金额和频次异常数据的筛选,大多利用监控软件数据筛选高效和精准的特性,将日常积累的管理经验利用设
Knowledge base is the accumulation of norms and experiences of a work in a field. In the medical insurance monitoring work, the knowledge base is embodied in the monitoring rules and monitoring means. The norms and experiences accumulated during the daily management of health insurance can be transformed into a management knowledge base to improve the efficiency of health insurance monitoring. Clinical norms and rules can be accumulated into clinical knowledge bases to enrich the means of monitoring health insurance. At present, the medical insurance monitoring is in the stage of research and exploration. The monitoring rules are more reflected in the screening of the abnormal data of the amount and frequency in the medical insurance settlement data. Most of the monitoring software data is used to screen efficient and precise characteristics, and the daily accumulated management experience is utilized