Charge control method based on DRGs pre-grouping

Abstract

The invention discloses a charge control method based on DRGs pre-grouping. The method comprises the following steps: 1) data integration: adopting a charge control system to obtain data from a hospital hospitalization clinical system; 2) predicting grouping through an in-hospital grouping device; 3) predicting the cost and the number of hospitalization days according to medical insurance historical settlement data; 4) obtaining DRG average charge and average hospitalization days of the first month region through a medical insurance calculation platform; 5) performing real-time early warning; 6) performing DRG balance statistical analysis; and (7) monitoring the charge control state, and monitoring the change trends of the average hospitalization cost increase, the medicine proportion, the actual compensation ratio and the self-charge item cost proportion each time. Based on the pre-grouping technology, the method is extended to the diagnosis and treatment process of doctors, the real-time performance is higher, the attending doctors can manually assign grouping and complete calculation of real-time cost and expense when having objection on prediction grouping, hospitalization expense and cost factors can be predicted in real time, and the method is used for hospitals to better adapt to the DRG medical insurance payment mode of grouping related to disease diagnosis.

Description

technical field [0001] The invention belongs to the field of information technology, and in particular relates to a fee control method based on DRGs pre-grouping. Background technique [0002] The current information system of my country's public hospitals can no longer adapt to the DRG payment method. If the hospital does not have a good method of cost control, it can only passively bear the increasingly heavy cost pressure. How to design a cost control method suitable for the DRG medical insurance payment method to adapt to the new situation of medical reform and solve various confusions caused by the DRG medical insurance payment method has become a difficult problem in modern hospital management. [0003] The shortcoming of prior art is as follows: [0004] 1. No intra-hospital grouping device; [0005] 2. The hospital can only check the amount of medical insurance settled by DRGs afterwards (the medical insurance settlement data needs to be fed back to the hospital in...

AI Technical Summary

Problems solved by technology

[0005] 2. The hospital can only check the amount of medical insurance settled by DRGs afterwards (the medical insurance settlement data needs to be fed back to the hospital in the next month);

[0006] 3. The medical insurance settlement data cannot be effectively counted and analyzed