Charge control method based on DRGs pre-grouping

A pre-grouping and costing technology, applied in the information field, can solve the problem that medical insurance settlement data cannot be effectively counted, and achieve the effect of high real-time performance

Pending Publication Date: 2021-04-13
浙江建达科技股份有限公司
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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

Method used

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Embodiment

[0026] A method for controlling fees based on DRGs pre-grouping, the steps are as follows:

[0027] 1) Data integration: use the cost control system to obtain data from the hospital inpatient clinical system;

[0028] 2) Predict the grouping through the intra-hospital grouping device;

[0029] 3) Predict expenses and hospitalization days based on historical medical insurance settlement data;

[0030] 4) Through the medical insurance calculation platform, obtain the average DRG fee and the average hospitalization days in the previous month;

[0031] 5) Real-time early warning: If the average cost of DRG in the region is exceeded, the cost of two days after the operation is too low, the cost of more than half of the hospitalization days is too low, and the proportion of medical expenses is too high.

[0032] 6) Statistical analysis of DRG balance: department balance analysis, doctor balance analysis, DRG disease group balance analysis, and analysis of the main reasons for over...

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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...

Claims

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Application Information

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IPC IPC(8): G16H40/40G06Q20/10
CPCG16H40/40G06Q20/102
Inventor 张亦雷徐翔张丛晓
Owner 浙江建达科技股份有限公司
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