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个人医疗帐户与社会统筹医疗基金相结合的职工医疗保险新制度在九江已经建立两年多了,新的筹资机制和制度保障了广大职工的基本医疗。在诸多的医疗保险管理中、报帐结算是整个医疗保险流程中的最终环节。如何在报帐结算中加强审核,合理地控制经费支出,遏制医疗浪费,又维护定点医疗单位和职工个人的经济利益,即该扣的扣下来,该报销的报出去。对此,我们进行了不断的探索和实践,总结两年多的作法,应重点监督检查以下几个问题。 一、严把医院报帐审核关,控制本地医疗消费总“闸门” 新的医疗保险制度规范了职工在定点医院就诊的原则,这就注定了定点医院是职工医疗消费的主要渠道。严格审核医院报帐,主要是两个方面。
The new medical insurance system for staff and workers with a combination of individual medical accounts and social pooling of medical funds has been established for more than two years in Jiujiang. The new funding mechanism and system guarantee the basic medical care of the vast numbers of staff and workers. In many medical insurance management, reporting and settlement is the final link in the entire medical insurance process. How to strengthen auditing in the settlement of accounts, reasonably control expenditures, curb medical waste, and maintain the economic interests of the designated medical units and individual employees, that is, if the deductions are deducted, the reimbursement should be reported out. In this regard, we conducted continuous exploration and practice, summed up more than two years of practice, we should focus on supervision and inspection of the following issues. First, the strict examination of the hospital reimbursement off the control of local medical spending Total “gate” The new medical insurance system standardized the principle of workers in designated hospitals, which is destined to designated hospitals is the main channel for medical expenses of workers. Strict review of hospital reimbursement, mainly in two aspects.