CAJ | 학술논문

目的：分析医保病案稽核中出现的问题，持续加强病历质控内涵管理。方法回顾性分析2014年全年各项病历质控检查记录，分析医保病历稽核中存在的问题及解决方案。结果稽核并跟踪的7000份病案中，存在问题的病案有1245份，不合格率17.8%。结论不断加强医保病案的内涵质量管理，合理使用医保基金，利用信息化扫除医保监管死角，提高医保病案稽核水平。
목적：분석의보병안계핵중출현적문제，지속가강병력질공내함관리。방법회고성분석2014년전년각항병력질공검사기록，분석의보병력계핵중존재적문제급해결방안。결과계핵병근종적7000빈병안중，존재문제적병안유1245빈，불합격솔17.8%。결론불단가강의보병안적내함질량관리，합리사용의보기금，이용신식화소제의보감관사각，제고의보병안계핵수평。
ObjectivesTo analyze the problems arising from the audit of medical insurance medical records,and strengthen the connotation management of medical records quality control continuously.Methods The full year 2014 medical records quality control inspection records were retrospectively analyzed,and discussed the problems existing in the audit of medical insurance medical records and relevant countermeasures.Results In all the more than 7000 cases of medical records that performed audit and follow up,there were problems existing in 1245 copies,and the failure rate was 17.8%.Conclusions We should strengthen the connotation management of medical records quality control continuously,apply the fund of medical insurance reasonably,take use of information technology to eliminate health supervision dead angle,so as to improve the audit level of medical insurance medical records.