Practice of medical insurance settlement list quality management in city L under the diagnosis intervention packet payment system
10.3760/cma.j.cn111325-20240909-00748
- VernacularTitle:DIP付费下L市医保结算清单质量管理实践
- Author:
Wei YU
1
;
Xueqin ZENG
;
Jianing LI
;
Changhao YANG
;
Hongru YANG
;
Wei HUANG
;
Ling LUO
;
Yunmeng LI
;
Xiao HUANG
Author Information
1. 西南医科大学附属医院病案管理部，泸州 646000
- Publication Type:Journal Article
- Keywords:
Medical insurance settlement list;
Quality control;
Management practice;
Diagnosis intervention packet payment
- From:
Chinese Journal of Hospital Administration
2025;41(5):354-359
- CountryChina
- Language:Chinese
-
Abstract:
The quality of medical insurance settlement lists directly affects the accuracy and rationality of medical insurance payments. This study analyzed the quality problems existing in L City′s 2023 medical insurance settlement list from three dimensions: integrity, standardization and rationality, and introduced a series of medical insurance settlement list quality management measures implemented with a problem-oriented approach. City L has effectively improved the overall quality of medical insurance settlement list by compiling local medical insurance settlement list filling standards, building a closed-loop model for quality control management of medical insurance settlement lists, establishing a quality grading management system for medical insurance settlement lists, and incorporating the quality of medical insurance settlement lists into performance appraisal and agreement management. The proportion of medical insurance settlement lists with quality problems in the city decreased from 8.12% (87 500 out of 1 077 300) in 2023 to 1.80% (20 700 out of 1 152 000) in 2024. The number of problems related to integrity, standardization, and rationality decreased from 39 900, 129 300, and 105 300 to 12 600, 14 800, and 24 800, respectively. These findings could provide a reference for medical insurance settlement list quality management in other regions.
