门诊患者医保实时结算拒付原因分析及对策

刘霞,舒军萍

武警医学 ›› 2012, Vol. 23 ›› Issue (4) : 336-338.

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PDF(799 KB)
武警医学 ›› 2012, Vol. 23 ›› Issue (4) : 336-338.
论著

门诊患者医保实时结算拒付原因分析及对策

  • 刘霞1,舒军萍2
作者信息 +

Causes of medical insurance payment refusal in real time settlement of accounts in outpatient clinics

  • LIU Xia and SHU Junping.
Author information +
文章历史 +

摘要

目的 自北京市医保中心实施门诊实时报销结算以来,我院被拒付的医疗保险统筹金随之增加。为保障医保患者正当的权益,减少医保拒付率的发生,本文针对医保拒付的原因进行分析,并提出相应的改进措施。

Abstract

Objective Since Beijing Medical Insurance Center began to settle accounts in real time in outpatient clinics, refusal of payment by fund of medical insurance increased markedly in this hospital. To safeguard the legal right and interests of the insured patients and reduce the incidence of refusal of payment, we analyzed the causes of medical insurance payment refusal and devised appropriate countermeasures.

关键词

基本医疗保险 / 实时结算 / 医保拒付

Key words

basic medical insurance / real time  / account settlement / medical insurance payment  / refuse

引用本文

导出引用
刘霞,舒军萍. 门诊患者医保实时结算拒付原因分析及对策[J]. 武警医学. 2012, 23(4): 336-338
LIU Xia,SHU Junping. Causes of medical insurance payment refusal in real time settlement of accounts in outpatient clinics[J]. Medical Journal of the Chinese People Armed Police Forces. 2012, 23(4): 336-338
中图分类号: R197.1   

参考文献

[1]尹世全.基本医疗保险拒付制度有效性分析[J].中国医院管理,2009,6(6):13-14.

[2]宫彦婷,常建国,荣文英,等.持卡就医实时结算,促进医院信息化系统高度整合[J]. 医疗卫生设备,2010,31(8):101-102.

[3]李娜,吕裕霞,程莉,等.医疗保险院端日常审核中的问题及对策[J].武警医学,2010,21(8):712-713

[4]董盛霞,王涤非.医疗费用信息网络化管理漏费现象分析与对策[J]中国医院,2005,9(12):35-36.

[5]文光慧,李印文.降低医疗保险拒付率[J].中国卫生质量管理,2005,6(12):43-44.

[6]王松祥, 赖瑞南.医保拒付医疗费用的原因及对策[J].卫生经济研究,2011,3(285):35-36.

[7]郭美美.医保拒付原因分析及对策[J].解放军医院管理杂志,2007,14(12):913-914.

基金

全军医学科技“十二五”科研项目(11BJZ08)


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