Medical insurance integrated management system and management method based on DRG/DIP full-process medical quality supervision

Abstract

The invention discloses a medical insurance integrated management system and management method based on DRG / DIP full-process medical quality supervision. On one hand, the medical insurance integrated management system based on DRG / DIP full-process medical quality supervision comprises a DRG / DIP analysis unit, a single disease type auditing unit, a hospital entry and exit auditing unit, a medical record home page auditing unit and a commodity price charging auditing unit which are connected with a hospital HIS system in real time, and provides data management support for all departments of a hospital. On the other hand, the invention further provides a management method of the medical insurance comprehensive management system based on DRG / DIP full-process medical quality supervision, the DIP medical insurance service of the hospital end is divided into a plurality of units in the data process for service processing for the first time, and the fine management capacity of the hospital is improved. The system has the advantages of performing full-process management and analysis on hospital DIP medical insurance service data, automatically querying and auditing suspicious illegal medical insurance data and maintaining the safety of medical insurance funds.

Description

Technical field [0001] The present invention relates to the field of medical insurance information management, and more particularly to a medical insurance integrated management system and management method based on DRG / DIP full process medical quality supervision. Background technique [0002] In recent years, with the reform of Diagnosis-Intervention Packet, DIP, the medical policy is reforms, in order to protect the implementation of DIP policy, the practicality, stability and scalability requirements of hospital medical insurance information management systems are increasing. high. Especially the hospital DIP operation, DIP data management and DIP data analysis have become an essential part of the implementation of the hospital in various DIP policies. In addition, the "Regulations on the Administration of Medical Savory Fund" implemented on May 1, 2021 is a higher requirements for fund supervision. Daily supervision methods need to adapt to the characteristics of the medic...

AI Technical Summary

Problems solved by technology

However, in the process of using the existing medical insurance comprehensive management system, although it has data query and management functions, and can design medical insurance business processes and manage data according to the current DIP policy, it lacks a set of DIP medical insurance services suitable for hospitals. The data management process cannot further automatically query, review and analyze the suspected illegal DIP data in the hospital's HIS system. In the process of data review, it is necessary to collect and judge the data manually, which not only cannot realize the comprehensive data of the hospital's DIP medical insurance business. Process management, and it is difficult to effectively guarantee the hospital's reasonable diagnosis and treatment charges, medical quality and effective supervision of medical insurance funds, and it is difficult to meet the actual DIP medical insurance business management needs of the hospital

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