Practice and exploration of whole scene intelligent management of medical insurance in public hospitals
10.3760/cma.j.cn111325-20211208-01109
- VernacularTitle:公立医院医保全场景智能管理探索
- Author:
Dan LI
1
;
Fan OU
;
Rui WU
;
Xiaohong YANG
Author Information
1. 广东省人民医院（广东省医学科学院）信息管理处，广州 510080
- Keywords:
Hospitals, public;
Smart management;
Intelligent management of medical insurance;
Panoramic scene
- From:
Chinese Journal of Hospital Administration
2022;38(2):92-96
- CountryChina
- Language:Chinese
-
Abstract:
With the reform of medical insurance payment mode and the promotion of medical insurance policy, medical insurance management has become the core of public hospital operation and management. According to the business scenario of medical insurance management in public hospitals, medical insurance intelligent management can be divided into three levels: automatic medical insurance intelligent management engine based on rules, digital medical insurance management assistance based on dialogue user interface and hospital medical insurance management brain based on deep learning. In August 2020, under the requirements of hospital intelligent management standards, a tertiary hospital broke through the traditional medical insurance management mode to launch the practice of digital enabled panoramic scene intelligent management of medical insurance, which included medical insurance intelligent business audit, medical insurance intelligent reconciliation, medical insurance intelligent cost control and medical insurance intelligent management cockpit. These measures had realized the intellectualization and standardization of medical insurance management and improved the overall operation efficiency of the hospital.
