基于医保规则的智能审核平台设计与应用

摘要

目的:实时监控对病人的医疗行为,规避医保违规事件,减少医保扣款.方法:设计开发基于医保规则的智能审核平台,实现医疗服务行为的事前引导、事中监控、事后追查.结果:医生使用具有用药提示功能的医生站,大大减少了违反医保规则的医疗行为.结论:智能审核平台的应用,完善了医院的信息系统,规范了医疗行为,减少了医患纠纷,改善了医院的服务水平.%Objective: To realize real-time monitoring of patient' s medical behavior, avoid medical insurance violations and reduce medical insurance deduction. Methods: Design and develop an intelligent auditing system which based on the rules of medical insurance, to achieve the pre-guidance, process monitoring and after-tracing in course of medical treatment. Results: Applying doctor workstation with medication tips function has greatly reduced medical events that violate the rules of medical insurance. Conclusion: The application of intelligent auditing system, regulate the medical behaviors, reduce the medical disputes, improve hospital' s service level and perfect hospital' s information system.